- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.40 / $3,213.00 / $7,365.00
| Facility | | $1,334.40 | $3,213.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $760.05 / $5,698.00
| Facility | | $55.00 | $760.05 | $5,698.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.14 / $826.90 / $826.90
| Facility | AS | $112.14 | $826.90 | $826.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,502.00 / $6,854.00
| Facility | | $1,708.00 | $3,502.00 | $6,854.00 |