- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.32 / $4,790.00 / $11,576.00
| Facility | | $112.32 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.38 / $374.73 / $2,530.00
| Facility | | $136.38 | $374.73 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $13.27 / $13.27 / $13.27
| Facility | AS | $13.27 | $13.27 | $13.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $19,859.00 / $31,911.00
| Facility | | $6,600.00 | $19,859.00 | $31,911.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |