- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.51 / $2,678.00 / $7,602.00
| Facility | | $933.51 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,216.00 / $10,205.00 / $17,412.00
| Facility | | $5,216.00 | $10,205.00 | $17,412.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,275.28 / $2,321.66
| Facility | | $55.00 | $2,275.28 | $2,321.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $115.81 / $232.17 / $232.17
| Facility | AS | $115.81 | $232.17 | $232.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |