- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.93 / $3,617.00 / $8,247.00
| Facility | | $302.93 | $3,617.00 | $8,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.00 / $12,014.00 / $22,154.73
| Facility | | $6,085.00 | $12,014.00 | $22,154.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $1,000.00
| Facility | | $550.00 | $550.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $29.53 / $29.53 / $29.53
| Facility | AS | $29.53 | $29.53 | $29.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |