- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.40 / $5,493.00 / $8,262.00
| Facility | | $609.40 | $5,493.00 | $8,262.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $4,161.00 / $9,854.00
| Facility | | $2,486.00 | $4,161.00 | $9,854.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,806.00 / $10,806.00 / $10,806.00
| Facility | | $10,806.00 | $10,806.00 | $10,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.39 / $502.11 / $959.04
| Facility | | $348.39 | $502.11 | $959.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.30 / $95.30 / $1,537.78
| Facility | AS | $95.30 | $95.30 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,893.85 / $6,980.00 / $8,482.00
| Facility | | $2,893.85 | $6,980.00 | $8,482.00 |