- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.45 / $2,678.00 / $17,520.43
| Facility | | $952.45 | $2,678.00 | $17,520.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.00 / $9,558.00 / $16,629.00
| Facility | | $2,816.00 | $9,558.00 | $16,629.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $11,883.00 / $12,128.60
| Facility | | $55.00 | $11,883.00 | $12,128.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.06 / $513.29 / $513.29
| Facility | AS | $254.06 | $513.29 | $513.29 |
- 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 |