- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.83 / $4,470.00 / $12,154.00
| Facility | | $256.83 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $12,235.48
| Facility | | $2,224.00 | $4,490.00 | $12,235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.30 / $380.02 / $3,500.00
| Facility | | $178.30 | $380.02 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.90 / $102.75 / $102.75
| Facility | AS | $50.90 | $102.75 | $102.75 |
- 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 |