- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,754.40 / $12,022.64
| Facility | | $977.24 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $8,709.64 / $9,120.11
| Facility | | $616.60 | $8,709.64 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,302.69 / $18,620.87
| Facility | | $4,365.16 | $12,302.69 | $18,620.87 |