- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.09 / $2,678.00 / $7,602.00
| Facility | | $1,046.09 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $143.00 / $388.00
| Facility | | $108.00 | $143.00 | $388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,408.46 / $2,481.73
| Facility | | $55.00 | $2,408.46 | $2,481.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.84 / $248.17 / $248.17
| Facility | AS | $128.84 | $248.17 | $248.17 |
- 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 |