- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.75 / $2,276.00 / $5,506.00
| Facility | | $341.75 | $2,276.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.10 / $1,143.18 / $1,810.96
| Facility | | $294.10 | $1,143.18 | $1,810.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.12 / $121.39 / $1,448.00
| Facility | | $84.12 | $121.39 | $1,448.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.57 / $40.57 / $40.57
| Facility | AS | $40.57 | $40.57 | $40.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,326.00
| Facility | | $704.00 | $1,535.00 | $2,326.00 |