- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.74 / $4,908.00 / $9,823.00
| Facility | | $911.74 | $4,908.00 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $10,961.39
| Facility | | $2,224.00 | $4,490.00 | $10,961.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.41 / $1,135.72 / $5,007.20
| Facility | | $582.41 | $1,135.72 | $5,007.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.04 / $347.57 / $347.57
| Facility | AS | $193.04 | $347.57 | $347.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,858.00 / $4,000.00 / $10,781.00
| Facility | | $1,858.00 | $4,000.00 | $10,781.00 |