- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.00 / $2,260.00 / $5,234.00
| Facility | | $688.00 | $2,260.00 | $5,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.16 / $2,327.82 / $3,616.69
| Facility | | $601.16 | $2,327.82 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.04 / $848.60 / $9,251.00
| Facility | | $577.04 | $848.60 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.94 / $181.94 / $2,570.85
| Facility | AS | $181.94 | $181.94 | $2,570.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |