- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.71 / $4,470.00 / $12,154.00
| Facility | | $186.71 | $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
- $141.69 / $253.06 / $3,516.00
| Facility | | $141.69 | $253.06 | $3,516.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.04 / $69.33 / $69.33
| Facility | AS | $37.04 | $69.33 | $69.33 |
- 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 |