- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $3,437.00 / $7,467.00
| Facility | | $936.00 | $3,437.00 | $7,467.00 |
- 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
- $404.60 / $551.02 / $3,787.00
| Facility | | $404.60 | $551.02 | $3,787.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.42 / $108.42 / $380.79
| Facility | AS | $108.42 | $108.42 | $380.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |