- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.62 / $3,131.00 / $7,365.00
| Facility | | $545.62 | $3,131.00 | $7,365.00 |
- 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
- $422.96 / $706.13 / $8,660.15
| Facility | | $422.96 | $706.13 | $8,660.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.86 / $118.86 / $849.00
| Facility | AS | $118.86 | $118.86 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |