- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.25 / $2,782.00 / $8,000.00
| Facility | | $505.25 | $2,782.00 | $8,000.00 |
- 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
- $424.33 / $717.28 / $3,006.00
| Facility | | $424.33 | $717.28 | $3,006.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.49 / $196.49 / $196.49
| Facility | AS | $196.49 | $196.49 | $196.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |