- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.07 / $2,940.00 / $7,602.00
| Facility | | $784.07 | $2,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,419.00
| Facility | | $2,695.00 | $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
- $177.57 / $1,678.13 / $1,678.13
| Facility | AS | $177.57 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,709.00 / $10,111.00
| Facility | | $2,799.00 | $5,709.00 | $10,111.00 |