- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,211.19 / $3,616.69
| Facility | | $587.35 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.57 / $987.29 / $3,978.00
| Facility | | $742.57 | $987.29 | $3,978.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.37 / $202.37 / $497.27
| Facility | AS | $202.37 | $202.37 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.04 / $3,132.00 / $5,838.00
| Facility | | $1,665.04 | $3,132.00 | $5,838.00 |