- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.31 / $4,470.00 / $12,154.00
| Facility | | $910.31 | $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
- $55.00 / $1,358.09 / $6,890.00
| Facility | | $55.00 | $1,358.09 | $6,890.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.61 / $324.70 / $324.70
| Facility | AS | $173.61 | $324.70 | $324.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $2,693.00 / $11,134.00
| Facility | | $1,367.00 | $2,693.00 | $11,134.00 |