- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.22 / $2,718.84 / $10,234.00
| Facility | | $2,006.22 | $2,718.84 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $5,065.00
| Facility | | $1,275.00 | $2,326.00 | $5,065.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $18,508.80 / $18,944.64
| Facility | | $55.00 | $18,508.80 | $18,944.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $252.54 / $490.96 / $490.96
| Facility | AS | $252.54 | $490.96 | $490.96 |
- 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 |