- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.88 / $3,382.00 / $7,283.00
| Facility | | $1,408.88 | $3,382.00 | $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
- $694.03 / $927.15 / $7,167.00
| Facility | | $694.03 | $927.15 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.66 / $186.66 / $2,387.48
| Facility | AS | $186.66 | $186.66 | $2,387.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |