- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.29 / $3,606.50 / $8,074.63
| Facility | | $642.29 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $11,253.00
| Facility | | $3,302.10 | $6,548.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,028.59 / $2,028.59 / $2,682.89
| Facility | | $2,028.59 | $2,028.59 | $2,682.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.26 / $67.26 / $67.26
| Facility | AS | $67.26 | $67.26 | $67.26 |
- 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 |