- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.53 / $3,697.00 / $8,000.00
| Facility | | $706.53 | $3,697.00 | $8,000.00 |
- 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
- $539.05 / $873.40 / $3,006.00
| Facility | | $539.05 | $873.40 | $3,006.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $247.81 / $247.81 / $247.81
| Facility | AS | $247.81 | $247.81 | $247.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |