- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.37 / $3,907.00 / $9,304.00
| Facility | | $870.37 | $3,907.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.04 / $1,036.04 / $21,310.46
| Facility | | $624.04 | $1,036.04 | $21,310.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.07 / $174.07 / $2,401.96
| Facility | AS | $174.07 | $174.07 | $2,401.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.66 / $4,390.00 / $12,989.00
| Facility | | $2,317.66 | $4,390.00 | $12,989.00 |