- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $6,329.00
| Facility | | $1,671.00 | $3,437.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.06 / $3,321.60 / $5,432.89
| Facility | | $903.06 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.28 / $25.79 / $1,919.00
| Facility | | $16.28 | $25.79 | $1,919.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3.82 / $3.82 / $7.11
| Facility | AS | $3.82 | $3.82 | $7.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |