- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.34 / $4,580.24 / $8,602.00
| Facility | | $780.34 | $4,580.24 | $8,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $4,343.00 / $10,957.00
| Facility | | $2,486.00 | $4,343.00 | $10,957.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.38 / $852.05 / $3,231.47
| Facility | | $470.38 | $852.05 | $3,231.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.23 / $46.23 / $46.23
| Facility | AS | $46.23 | $46.23 | $46.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.00 / $5,632.00 / $12,349.00
| Facility | | $2,358.00 | $5,632.00 | $12,349.00 |