- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.37 / $3,313.00 / $7,975.63
| Facility | | $944.37 | $3,313.00 | $7,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,157.22 / $11,031.52 / $22,090.61
| Facility | | $5,157.22 | $11,031.52 | $22,090.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.65 / $905.65 / $1,254.56
| Facility | | $905.65 | $905.65 | $1,254.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.96 / $88.96 / $88.96
| Facility | AS | $88.96 | $88.96 | $88.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,133.00 / $19,962.00
| Facility | | $4,873.00 | $10,133.00 | $19,962.00 |