- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.34 / $4,182.00 / $7,960.15
| Facility | | $946.34 | $4,182.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.18 / $620.79 / $6,063.00
| Facility | | $466.18 | $620.79 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.36 / $124.36 / $849.00
| Facility | AS | $124.36 | $124.36 | $849.00 |
- 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 |