- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.87 / $3,520.00 / $7,996.00
| Facility | | $844.87 | $3,520.00 | $7,996.00 |
- 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
- $621.45 / $1,050.40 / $3,500.00
| Facility | | $621.45 | $1,050.40 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.01 / $182.01 / $736.98
| Facility | AS | $182.01 | $182.01 | $736.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,874.00 / $5,829.00
| Facility | | $1,438.00 | $2,874.00 | $5,829.00 |