- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.46 / $2,752.00 / $6,323.00
| Facility | | $701.46 | $2,752.00 | $6,323.00 |
- 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
- $361.10 / $523.91 / $3,311.00
| Facility | | $361.10 | $523.91 | $3,311.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.01 / $165.01 / $165.01
| Facility | AS | $165.01 | $165.01 | $165.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.00 / $3,339.00 / $5,838.00
| Facility | | $2,381.00 | $3,339.00 | $5,838.00 |