- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.52 / $5,866.00 / $16,467.00
| Facility | | $959.52 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,041.58 / $6,537.29 / $11,190.33
| Facility | | $3,041.58 | $6,537.29 | $11,190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.18 / $1,151.42 / $1,731.81
| Facility | | $877.18 | $1,151.42 | $1,731.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.37 / $187.60 / $229.90
| Facility | AS | $132.37 | $187.60 | $229.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |