- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.06 / $3,321.60 / $5,432.89
| Facility | | $903.06 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.61 / $400.79 / $4,199.00
| Facility | | $188.61 | $400.79 | $4,199.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $44.13 / $44.13 / $104.62
| Facility | AS | $44.13 | $44.13 | $104.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.00 / $2,572.00 / $5,261.00
| Facility | | $1,413.00 | $2,572.00 | $5,261.00 |