- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $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
- $404.23 / $549.15 / $6,063.00
| Facility | | $404.23 | $549.15 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.89 / $108.89 / $2,386.34
| Facility | AS | $108.89 | $108.89 | $2,386.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |