- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.23 / $4,470.00 / $12,154.00
| Facility | | $962.23 | $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
- $694.37 / $1,271.75 / $7,903.00
| Facility | | $694.37 | $1,271.75 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.53 / $362.41 / $362.41
| Facility | AS | $195.53 | $362.41 | $362.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |