- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.25 / $3,819.00 / $7,467.00
| Facility | | $1,507.25 | $3,819.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.54 / $711.44 / $7,341.00
| Facility | | $470.54 | $711.44 | $7,341.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.66 / $219.66 / $219.66
| Facility | AS | $219.66 | $219.66 | $219.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $6,742.00 / $11,396.00
| Facility | | $5,255.00 | $6,742.00 | $11,396.00 |