- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.50 / $3,396.76 / $7,644.00
| Facility | | $858.50 | $3,396.76 | $7,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,286.00 / $9,663.00
| Facility | | $2,088.00 | $4,286.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.35 / $1,023.96 / $19,067.25
| Facility | | $613.35 | $1,023.96 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.49 / $171.49 / $1,887.52
| Facility | AS | $171.49 | $171.49 | $1,887.52 |
- 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 |