- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.53 / $4,521.00 / $9,325.00
| Facility | | $864.53 | $4,521.00 | $9,325.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $12,274.00
| Facility | | $3,877.00 | $7,264.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.02 / $2,344.25 / $3,090.32
| Facility | | $2,322.02 | $2,344.25 | $3,090.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.01 / $69.01 / $69.01
| Facility | AS | $69.01 | $69.01 | $69.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |