- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.43 / $3,392.50 / $8,238.00
| Facility | | $939.43 | $3,392.50 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,088.00 / $9,565.00 / $17,206.00
| Facility | | $5,088.00 | $9,565.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.70 / $904.70 / $1,249.30
| Facility | | $904.70 | $904.70 | $1,249.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.58 / $88.58 / $88.58
| Facility | AS | $88.58 | $88.58 | $88.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |