- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.74 / $4,192.00 / $10,034.00
| Facility | | $662.74 | $4,192.00 | $10,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,898.00 / $7,264.00 / $16,106.00
| Facility | | $2,898.00 | $7,264.00 | $16,106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.00 / $1,537.42 / $3,959.16
| Facility | | $629.00 | $1,537.42 | $3,959.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $38.74 / $38.74 / $38.74
| Facility | AS | $38.74 | $38.74 | $38.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.50 / $5,742.00 / $11,732.00
| Facility | | $1,868.50 | $5,742.00 | $11,732.00 |