- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.74 / $3,861.22 / $9,005.81
| Facility | | $786.74 | $3,861.22 | $9,005.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,881.00 / $13,523.26
| Facility | | $3,302.10 | $5,881.00 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.50 / $1,684.77 / $2,438.72
| Facility | | $842.50 | $1,684.77 | $2,438.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.89 / $55.89 / $55.89
| Facility | AS | $55.89 | $55.89 | $55.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,622.00
| Facility | | $2,200.00 | $5,111.00 | $9,622.00 |