- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.50 / $2,300.00 / $5,506.00
| Facility | | $995.50 | $2,300.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.35 / $2,467.19 / $4,035.41
| Facility | | $655.35 | $2,467.19 | $4,035.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.80 / $405.88 / $7,247.00
| Facility | | $302.80 | $405.88 | $7,247.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.37 / $76.37 / $146.69
| Facility | AS | $76.37 | $76.37 | $146.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $2,057.00 / $8,995.00
| Facility | | $1,078.00 | $2,057.00 | $8,995.00 |