- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.53 / $3,214.00 / $7,365.00
| Facility | | $522.53 | $3,214.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.03 / $616.29 / $3,006.00
| Facility | | $356.03 | $616.29 | $3,006.00 |
- 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
- $1,438.00 / $2,874.00 / $5,813.00
| Facility | | $1,438.00 | $2,874.00 | $5,813.00 |