- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.43 / $5,797.00 / $11,576.00
| Facility | | $377.43 | $5,797.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.38 / $470.38 / $6,644.00
| Facility | | $470.38 | $470.38 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.23 / $46.23 / $46.23
| Facility | AS | $46.23 | $46.23 | $46.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.36 / $6,821.00 / $22,063.00
| Facility | | $1,730.36 | $6,821.00 | $22,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.00 / $10,236.00 / $17,744.00
| Facility | | $2,392.00 | $10,236.00 | $17,744.00 |