- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.98 / $4,261.00 / $10,043.00
| Facility | | $514.98 | $4,261.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.68 / $740.38 / $8,660.15
| Facility | | $455.68 | $740.38 | $8,660.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.18 / $127.18 / $849.00
| Facility | AS | $127.18 | $127.18 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |