- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.12 / $3,606.50 / $8,238.00
| Facility | | $708.12 | $3,606.50 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,030.00 / $17,424.00
| Facility | | $5,470.00 | $9,030.00 | $17,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.00 / $1,283.82 / $1,793.26
| Facility | | $891.00 | $1,283.82 | $1,793.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.31 / $64.31 / $64.31
| Facility | AS | $64.31 | $64.31 | $64.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |