- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.68 / $4,470.00 / $13,151.00
| Facility | | $162.68 | $4,470.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,517.00 / $21,396.74
| Facility | | $2,224.00 | $4,517.00 | $21,396.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $308.14 / $7,500.00
| Facility | | $55.00 | $308.14 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.81 / $57.68 / $57.68
| Facility | AS | $30.81 | $57.68 | $57.68 |
- 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 |