- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.80 / $2,678.00 / $7,602.00
| Facility | | $1,408.80 | $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 / $3,247.12 / $3,344.67
| Facility | | $55.00 | $3,247.12 | $3,344.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.61 / $334.47 / $334.47
| Facility | AS | $173.61 | $334.47 | $334.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,512.00 / $4,626.00
| Facility | | $1,233.00 | $2,512.00 | $4,626.00 |