- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.39 / $3,362.00 / $7,996.00
| Facility | | $706.39 | $3,362.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.46 / $1,040.25 / $3,532.00
| Facility | | $590.46 | $1,040.25 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.86 / $176.86 / $646.16
| Facility | AS | $176.86 | $176.86 | $646.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |