- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.00 / $2,956.00 / $7,960.15
| Facility | | $808.00 | $2,956.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.40 / $770.65 / $1,350.37
| Facility | | $206.40 | $770.65 | $1,350.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.35 / $220.92 / $849.23
| Facility | | $176.35 | $220.92 | $849.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.38 / $84.92 / $84.92
| Facility | AS | $45.38 | $84.92 | $84.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.00 / $1,488.00 / $2,057.00
| Facility | | $285.00 | $1,488.00 | $2,057.00 |