- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.50 / $4,081.00 / $10,043.00
| Facility | | $840.50 | $4,081.00 | $10,043.00 |
- 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
- $271.39 / $519.42 / $19,913.50
| Facility | | $271.39 | $519.42 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.72 / $78.72 / $1,887.52
| Facility | AS | $78.72 | $78.72 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,347.00 / $6,854.00
| Facility | | $1,748.00 | $3,347.00 | $6,854.00 |