- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.15 / $6,024.00 / $11,576.00
| Facility | | $852.15 | $6,024.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $2,845.35
| Facility | | $400.00 | $500.00 | $2,845.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.00 / $21,162.00 / $32,051.00
| Facility | | $9,624.00 | $21,162.00 | $32,051.00 |
- 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 |