- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,717.58 / $2,678.00 / $7,602.00
| Facility | | $1,717.58 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,326.00 / $4,232.00
| Facility | | $1,417.00 | $2,326.00 | $4,232.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,518.72 / $14,816.96
| Facility | | $55.00 | $14,518.72 | $14,816.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $198.67 / $387.86 / $387.86
| Facility | AS | $198.67 | $387.86 | $387.86 |
- 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 |