- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.50 / $3,131.00 / $7,365.00
| Facility | | $738.50 | $3,131.00 | $7,365.00 |
- 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
- $513.82 / $842.00 / $5,246.20
| Facility | | $513.82 | $842.00 | $5,246.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $143.22 / $143.22 / $497.27
| Facility | AS | $143.22 | $143.22 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |