- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.12 / $3,491.00 / $7,365.00
| Facility | | $862.12 | $3,491.00 | $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
- $665.75 / $1,095.40 / $19,067.25
| Facility | | $665.75 | $1,095.40 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.66 / $186.66 / $2,387.48
| Facility | AS | $186.66 | $186.66 | $2,387.48 |
- 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 |