- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.12 / $4,470.00 / $12,154.00
| Facility | | $839.12 | $4,470.00 | $12,154.00 |
- 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
- $601.60 / $989.57 / $21,310.46
| Facility | | $601.60 | $989.57 | $21,310.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $166.76 / $166.76 / $2,440.41
| Facility | AS | $166.76 | $166.76 | $2,440.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,502.00 / $6,854.00
| Facility | | $1,708.00 | $3,502.00 | $6,854.00 |