- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.37 / $2,678.00 / $7,602.00
| Facility | | $499.37 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,387.00 / $6,090.00
| Facility | | $1,417.00 | $2,387.00 | $6,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,300.00 / $1,300.00
| Facility | | $55.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.87 / $119.42 / $119.42
| Facility | AS | $61.87 | $119.42 | $119.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,827.00 / $14,882.00 / $33,761.00
| Facility | | $6,827.00 | $14,882.00 | $33,761.00 |