- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,936.00 / $7,467.00
| Facility | | $1,965.00 | $3,936.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.98 / $961.08 / $7,167.00
| Facility | | $711.98 | $961.08 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.35 / $194.35 / $1,887.52
| Facility | AS | $194.35 | $194.35 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |