- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.25 / $4,587.00 / $11,022.00
| Facility | | $478.25 | $4,587.00 | $11,022.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.49 / $564.16 / $1,047.62
| Facility | | $490.49 | $564.16 | $1,047.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $27.81 / $27.81 / $27.81
| Facility | AS | $27.81 | $27.81 | $27.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $1,221.00 / $2,883.00
| Facility | | $376.00 | $1,221.00 | $2,883.00 |