- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.93 / $4,005.00 / $8,622.00
| Facility | | $656.93 | $4,005.00 | $8,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,136.00
| Facility | | $3,248.00 | $5,196.00 | $11,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.20 / $1,527.95 / $2,172.58
| Facility | | $883.20 | $1,527.95 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.52 / $56.52 / $56.52
| Facility | AS | $56.52 | $56.52 | $56.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |