- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.73 / $3,445.53 / $7,365.00
| Facility | | $896.73 | $3,445.53 | $7,365.00 |
- 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
- $695.27 / $1,133.52 / $19,067.25
| Facility | | $695.27 | $1,133.52 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.63 / $191.63 / $2,474.92
| Facility | AS | $191.63 | $191.63 | $2,474.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |