- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.42 / $4,433.00 / $10,396.00
| Facility | | $160.42 | $4,433.00 | $10,396.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $26,922.00 / $68,628.00
| Facility | | $9,496.00 | $26,922.00 | $68,628.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.37 / $379.01 / $942.47
| Facility | | $296.37 | $379.01 | $942.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | AS | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |