- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.38 / $5,094.56 / $11,901.00
| Facility | | $644.38 | $5,094.56 | $11,901.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $1,393.45 / $2,213.00
| Facility | | $432.00 | $1,393.45 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.44 / $77.44 / $77.44
| Facility | AS | $77.44 | $77.44 | $77.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,433.94 / $6,499.00 / $11,885.00
| Facility | | $3,433.94 | $6,499.00 | $11,885.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.00 / $7,558.00 / $12,040.00
| Facility | | $1,788.00 | $7,558.00 | $12,040.00 |