- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.27 / $4,470.00 / $8,538.36
| Facility | | $787.27 | $4,470.00 | $8,538.36 |
- 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
- $568.34 / $928.52 / $8,957.00
| Facility | | $568.34 | $928.52 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.71 / $157.71 / $849.00
| Facility | AS | $157.71 | $157.71 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,502.00 / $6,854.00
| Facility | | $1,708.00 | $3,502.00 | $6,854.00 |