- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.50 / $3,038.00 / $7,838.38
| Facility | | $320.50 | $3,038.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $10,517.23
| Facility | | $3,302.10 | $6,548.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.27 / $719.22 / $1,160.08
| Facility | | $575.27 | $719.22 | $1,160.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.22 / $28.22 / $28.22
| Facility | AS | $28.22 | $28.22 | $28.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,891.00 / $13,779.00 / $32,316.00
| Facility | | $5,891.00 | $13,779.00 | $32,316.00 |