- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.07 / $2,640.00 / $7,987.01
| Facility | | $121.07 | $2,640.00 | $7,987.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,418.00 / $9,274.00
| Facility | | $2,088.00 | $4,418.00 | $9,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.22 / $207.89 / $615.05
| Facility | | $161.22 | $207.89 | $615.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7.76 / $7.76 / $7.76
| Facility | AS | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |