- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.83 / $3,454.40 / $8,229.00
| Facility | | $949.83 | $3,454.40 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.00 / $7,264.00 / $12,274.00
| Facility | | $4,100.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,802.59 / $4,802.59 / $5,765.88
| Facility | | $4,802.59 | $4,802.59 | $5,765.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.51 / $100.51 / $100.51
| Facility | AS | $100.51 | $100.51 | $100.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |