- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.15 / $4,470.00 / $12,154.00
| Facility | | $798.15 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $12,235.48
| Facility | | $2,224.00 | $4,490.00 | $12,235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.70 / $1,037.44 / $7,294.00
| Facility | | $605.70 | $1,037.44 | $7,294.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $164.22 / $302.45 / $302.45
| Facility | AS | $164.22 | $302.45 | $302.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.00 / $5,252.00 / $19,082.00
| Facility | | $2,578.00 | $5,252.00 | $19,082.00 |