- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.74 / $4,848.57 / $9,861.00
| Facility | | $841.74 | $4,848.57 | $9,861.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,881.00 / $13,523.26
| Facility | | $3,302.10 | $5,881.00 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.50 / $1,697.04 / $2,483.65
| Facility | | $842.50 | $1,697.04 | $2,483.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $59.43 / $59.43 / $59.43
| Facility | AS | $59.43 | $59.43 | $59.43 |
- 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 |