- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.03 / $2,678.00 / $7,602.00
| Facility | | $1,085.03 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,364.00 / $4,305.00 / $6,449.00
| Facility | | $2,364.00 | $4,305.00 | $6,449.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,984.00 / $7,984.00
| Facility | | $55.00 | $7,984.00 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.34 / $757.42 / $757.42
| Facility | AS | $135.34 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,567.00 / $7,604.00
| Facility | | $2,426.00 | $4,567.00 | $7,604.00 |