- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.96 / $4,470.00 / $8,000.00
| Facility | | $737.96 | $4,470.00 | $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
- $520.15 / $1,081.39 / $15,556.33
| Facility | | $520.15 | $1,081.39 | $15,556.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.78 / $1,196.53 / $1,196.53
| Facility | AS | $156.78 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.15 / $3,347.00 / $6,653.00
| Facility | | $1,813.15 | $3,347.00 | $6,653.00 |