- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,678.00 / $10,234.00
| Facility | | $1,821.00 | $2,678.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,272.00
| Facility | | $2,430.00 | $5,486.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $13,856.55 / $13,856.55
| Facility | | $55.00 | $13,856.55 | $13,856.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.97 / $1,314.53 / $1,314.53
| Facility | AS | $239.97 | $1,314.53 | $1,314.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,362.00
| Facility | | $3,964.00 | $8,273.00 | $12,362.00 |