- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,311.31 / $10,000.00
| Facility | | $549.54 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $323.59 / $398.11
| Facility | | $34.67 | $323.59 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,380.38 / $1,513.56
| Facility | | $1,288.25 | $1,380.38 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,737.80 / $4,168.69
| Facility | | $331.13 | $1,737.80 | $4,168.69 |