- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.50 / $2,640.00 / $20,000.00
| Facility | | $546.50 | $2,640.00 | $20,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.42 / $92.18 / $1,689.00
| Facility | | $64.42 | $92.18 | $1,689.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16.85 / $16.85 / $31.79
| Facility | AS | $16.85 | $16.85 | $31.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |