- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.84 / $3,048.50 / $7,602.00
| Facility | | $1,059.84 | $3,048.50 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,363.00 / $4,657.00 / $7,782.00
| Facility | | $2,363.00 | $4,657.00 | $7,782.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $12,623.50 / $12,623.50
| Facility | | $55.00 | $12,623.50 | $12,623.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.53 / $1,196.53 / $1,196.53
| Facility | AS | $135.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |