- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.68 / $151.26 / $4,846.00
| Facility | | $134.68 | $151.26 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.96 / $159.85 / $184.44
| Facility | | $122.96 | $159.85 | $184.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.57 / $160.57 / $761.00
| Facility | | $160.57 | $160.57 | $761.00 |
- 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
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |