- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.48 / $2,787.00 / $8,707.60
| Facility | | $774.48 | $2,787.00 | $8,707.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $8,455.00 / $16,490.00
| Facility | | $4,749.00 | $8,455.00 | $16,490.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.17 / $2,114.86 / $5,407.27
| Facility | | $740.17 | $2,114.86 | $5,407.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.45 / $73.45 / $73.45
| Facility | AS | $73.45 | $73.45 | $73.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |