- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $52,588.60
| Facility | | $1,671.00 | $4,521.00 | $52,588.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $4,934.39 / $8,070.83
| Facility | | $1,341.54 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.33 / $905.22 / $6,117.00
| Facility | | $574.33 | $905.22 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.34 / $135.34 / $757.42
| Facility | AS | $135.34 | $135.34 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |