- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.36 / $4,759.50 / $9,505.41
| Facility | | $983.36 | $4,759.50 | $9,505.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,247.00 / $8,800.00
| Facility | | $2,393.00 | $4,247.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.52 / $2,122.59 / $2,570.38
| Facility | | $1,871.52 | $2,122.59 | $2,570.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.55 / $83.55 / $83.55
| Facility | AS | $83.55 | $83.55 | $83.55 |
- 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 |