- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.50 / $2,507.00 / $7,365.00
| Facility | | $758.50 | $2,507.00 | $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
- $665.75 / $1,337.64 / $5,504.00
| Facility | | $665.75 | $1,337.64 | $5,504.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $228.14 / $2,454.02 / $2,454.02
| Facility | AS | $228.14 | $2,454.02 | $2,454.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,858.00 / $4,000.00 / $10,781.00
| Facility | | $1,858.00 | $4,000.00 | $10,781.00 |