- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.60 / $2,311.00 / $10,234.00
| Facility | | $795.60 | $2,311.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.00 / $9,123.00 / $16,629.00
| Facility | | $2,330.00 | $9,123.00 | $16,629.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,026.52 / $16,394.00 / $114,021.05
| Facility | | $3,026.52 | $16,394.00 | $114,021.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.22 / $10,807.58 / $10,807.58
| Facility | AS | $131.22 | $10,807.58 | $10,807.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,827.00 / $14,310.00 / $39,655.00
| Facility | | $6,827.00 | $14,310.00 | $39,655.00 |