- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.50 / $2,535.00 / $7,365.00
| Facility | | $758.50 | $2,535.00 | $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
- $592.54 / $1,016.62 / $16,394.00
| Facility | | $592.54 | $1,016.62 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.43 / $165.43 / $2,462.39
| Facility | AS | $165.43 | $165.43 | $2,462.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |