- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.05 / $3,617.00 / $7,283.00
| Facility | | $1,391.05 | $3,617.00 | $7,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,613.46 / $4,140.09
| Facility | | $672.35 | $2,613.46 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.25 / $930.90 / $9,251.00
| Facility | | $685.25 | $930.90 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.62 / $182.62 / $2,568.08
| Facility | AS | $182.62 | $182.62 | $2,568.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |