- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.25 / $3,370.00 / $6,329.00
| Facility | | $946.25 | $3,370.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.35 / $2,451.78 / $4,035.41
| Facility | | $655.35 | $2,451.78 | $4,035.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.08 / $307.64 / $1,868.00
| Facility | | $228.08 | $307.64 | $1,868.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $59.42 / $108.84 / $108.84
| Facility | AS | $59.42 | $108.84 | $108.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |