- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.34 / $4,994.00 / $9,823.00
| Facility | | $919.34 | $4,994.00 | $9,823.00 |
- 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
- $480.21 / $1,022.73 / $5,504.00
| Facility | | $480.21 | $1,022.73 | $5,504.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.57 / $1,678.13 / $1,678.13
| Facility | AS | $177.57 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,516.00 / $4,600.00 / $9,817.00
| Facility | | $2,516.00 | $4,600.00 | $9,817.00 |