- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.45 / $2,678.00 / $7,602.00
| Facility | | $1,009.45 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $150.00 / $2,056.00
| Facility | | $110.00 | $150.00 | $2,056.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $12,022.71 / $12,335.40
| Facility | | $55.00 | $12,022.71 | $12,335.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.41 / $239.62 / $239.62
| Facility | AS | $124.41 | $239.62 | $239.62 |
- 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 |