- 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
- $153.15 / $263.89 / $4,199.00
| Facility | | $153.15 | $263.89 | $4,199.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $35.54 / $35.54 / $67.06
| Facility | AS | $35.54 | $35.54 | $67.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $6,416.00
| Facility | | $1,424.00 | $3,269.00 | $6,416.00 |