- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.83 / $2,370.00 / $7,082.02
| Facility | | $486.83 | $2,370.00 | $7,082.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,464.00 / $7,875.00 / $12,691.00
| Facility | | $4,464.00 | $7,875.00 | $12,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.66 / $887.70 / $1,700.00
| Facility | | $709.66 | $887.70 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $35.86 / $35.86 / $35.86
| Facility | AS | $35.86 | $35.86 | $35.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $3,239.00
| Facility | | $293.00 | $1,158.00 | $3,239.00 |