- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.25 / $4,261.00 / $12,154.00
| Facility | | $550.25 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,500.00 / $11,467.00
| Facility | | $2,224.00 | $4,500.00 | $11,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.28 / $711.86 / $3,006.00
| Facility | | $409.28 | $711.86 | $3,006.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $188.17 / $188.17 / $188.17
| Facility | AS | $188.17 | $188.17 | $188.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,833.00 / $5,813.00
| Facility | | $1,438.00 | $2,833.00 | $5,813.00 |