- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.50 / $2,897.00 / $6,483.00
| Facility | | $1,181.50 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,283.06 / $3,616.69
| Facility | | $587.35 | $2,283.06 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.14 / $797.46 / $6,063.00
| Facility | | $594.14 | $797.46 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.81 / $158.81 / $1,887.52
| Facility | AS | $158.81 | $158.81 | $1,887.52 |
- 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 |