- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.72 / $5,348.00 / $10,177.86
| Facility | | $398.72 | $5,348.00 | $10,177.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,661.00 / $9,785.00
| Facility | | $2,224.00 | $4,661.00 | $9,785.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $10,806.00 / $10,806.00
| Facility | | $2,530.00 | $10,806.00 | $10,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.70 / $503.13 / $8,482.00
| Facility | | $306.70 | $503.13 | $8,482.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.55 / $1,537.78 / $1,537.78
| Facility | AS | $82.55 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $6,038.00 / $9,817.00
| Facility | | $2,285.00 | $6,038.00 | $9,817.00 |