- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.98 / $2,945.48 / $6,681.00
| Facility | | $1,077.98 | $2,945.48 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.00 / $5,138.00 / $7,782.00
| Facility | | $2,803.00 | $5,138.00 | $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
- $235.02 / $1,196.53 / $1,196.53
| Facility | AS | $235.02 | $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 |