- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.75 / $3,437.00 / $7,283.00
| Facility | | $1,866.75 | $3,437.00 | $7,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,613.46 / $4,140.09
| Facility | | $672.35 | $2,613.46 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.03 / $1,360.40 / $6,063.00
| Facility | | $546.03 | $1,360.40 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $290.61 / $290.61 / $4,526.82
| Facility | AS | $290.61 | $290.61 | $4,526.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |