- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.59 / $4,261.00 / $10,043.00
| Facility | | $981.59 | $4,261.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,464.43 / $6,653.00
| Facility | | $55.00 | $1,464.43 | $6,653.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.81 / $757.42 / $757.42
| Facility | AS | $193.81 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |