- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.66 / $2,897.00 / $6,483.00
| Facility | | $928.66 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,283.06 / $3,616.69
| Facility | | $587.35 | $2,283.06 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.47 / $648.19 / $3,790.00
| Facility | | $457.47 | $648.19 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.47 / $123.47 / $1,887.52
| Facility | AS | $123.47 | $123.47 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |