- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.00 / $3,048.50 / $6,681.00
| Facility | | $974.00 | $3,048.50 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.00 / $5,467.00 / $9,419.00
| Facility | | $2,830.00 | $5,467.00 | $9,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,704.40 / $17,704.40
| Facility | | $55.00 | $17,704.40 | $17,704.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.64 / $1,678.13 / $1,678.13
| Facility | AS | $176.64 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,728.00 / $10,111.00
| Facility | | $2,799.00 | $5,728.00 | $10,111.00 |