- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.28 / $4,878.59 / $9,626.68
| Facility | | $882.28 | $4,878.59 | $9,626.68 |
- 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 / $3,093.72
| Facility | | $2,322.02 | $2,344.25 | $3,093.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.31 / $69.31 / $69.31
| Facility | AS | $69.31 | $69.31 | $69.31 |
- 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 |