- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.78 / $1,609.33 / $16,467.00
| Facility | | $812.78 | $1,609.33 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.58 / $9,413.49 / $16,208.45
| Facility | | $3,608.58 | $9,413.49 | $16,208.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.66 / $922.21 / $1,403.85
| Facility | | $619.66 | $922.21 | $1,403.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.92 / $135.10 / $167.23
| Facility | AS | $101.92 | $135.10 | $167.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |