- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.56 / $3,907.00 / $12,154.00
| Facility | | $448.56 | $3,907.00 | $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 / $774.70 / $6,335.00
| Facility | | $55.00 | $774.70 | $6,335.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.10 / $159.86 / $159.86
| Facility | AS | $86.10 | $159.86 | $159.86 |
- 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 |