- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.86 / $4,790.00 / $11,576.00
| Facility | | $131.86 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.57 / $400.00 / $2,530.00
| Facility | | $160.57 | $400.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $15.62 / $15.62 / $15.62
| Facility | AS | $15.62 | $15.62 | $15.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.00 / $21,162.00 / $32,051.00
| Facility | | $9,624.00 | $21,162.00 | $32,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |