- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $2,830.82 / $8,485.00
| Facility | | $818.00 | $2,830.82 | $8,485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $5,617.00 / $12,691.00
| Facility | | $2,114.00 | $5,617.00 | $12,691.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.18 / $264.51 / $3,347.00
| Facility | | $155.18 | $264.51 | $3,347.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.35 / $40.35 / $75.98
| Facility | AS | $40.35 | $40.35 | $75.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,527.00 / $9,475.00
| Facility | | $1,708.00 | $3,527.00 | $9,475.00 |