- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.06 / $4,775.81 / $12,154.00
| Facility | | $881.06 | $4,775.81 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.75 / $1,116.27 / $8,957.00
| Facility | | $681.75 | $1,116.27 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $188.63 / $188.63 / $849.00
| Facility | AS | $188.63 | $188.63 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |