- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.84 / $2,281.00 / $7,147.02
| Facility | | $852.84 | $2,281.00 | $7,147.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $4,589.00 / $10,517.23
| Facility | | $3,248.00 | $4,589.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.95 / $1,306.21 / $2,172.58
| Facility | | $842.95 | $1,306.21 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |