- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.47 / $2,755.18 / $6,446.00
| Facility | | $986.47 | $2,755.18 | $6,446.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.00 / $5,196.00 / $8,456.00
| Facility | | $2,803.00 | $5,196.00 | $8,456.00 |
- 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
- $212.70 / $1,196.53 / $1,196.53
| Facility | AS | $212.70 | $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 |