- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.51 / $4,778.00 / $8,710.00
| Facility | | $871.51 | $4,778.00 | $8,710.00 |
- 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
- $677.51 / $1,370.93 / $15,556.33
| Facility | | $677.51 | $1,370.93 | $15,556.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $197.65 / $1,196.53 / $1,196.53
| Facility | AS | $197.65 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |