- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.85 / $2,485.00 / $7,500.00
| Facility | | $471.85 | $2,485.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $9,098.00 / $20,057.00
| Facility | | $4,755.00 | $9,098.00 | $20,057.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.82 / $505.82 / $641.21
| Facility | | $505.82 | $505.82 | $641.21 |
- 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 / $1,221.00 / $2,733.00
| Facility | | $293.00 | $1,221.00 | $2,733.00 |