- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.20 / $2,678.00 / $10,234.00
| Facility | | $1,625.20 | $2,678.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $138.00 / $388.00
| Facility | | $108.00 | $138.00 | $388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,814.81 / $4,036.46
| Facility | | $55.00 | $3,814.81 | $4,036.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.63 / $403.65 / $403.65
| Facility | AS | $206.63 | $403.65 | $403.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |