- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.55 / $3,940.00 / $7,602.00
| Facility | | $375.55 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,324.00 / $4,372.00
| Facility | | $1,275.00 | $2,324.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $52,504.62 / $53,823.63
| Facility | | $55.00 | $52,504.62 | $53,823.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $545.05 / $1,056.54 / $1,056.54
| Facility | AS | $545.05 | $1,056.54 | $1,056.54 |
- 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 |