- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.76 / $2,678.00 / $7,602.00
| Facility | | $804.76 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.00 / $7,138.00 / $13,623.00
| Facility | | $2,662.00 | $7,138.00 | $13,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $13,486.75 / $13,486.75
| Facility | | $55.00 | $13,486.75 | $13,486.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.00 / $1,279.44 / $1,279.44
| Facility | AS | $91.00 | $1,279.44 | $1,279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,728.00 / $10,111.00
| Facility | | $2,799.00 | $5,728.00 | $10,111.00 |