- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,168.57 / $3,940.00 / $7,602.00
| Facility | | $2,168.57 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,528.00
| Facility | | $1,275.00 | $2,326.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $28,498.40 / $29,180.32
| Facility | | $55.00 | $28,498.40 | $29,180.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $389.67 / $762.02 / $762.02
| Facility | AS | $389.67 | $762.02 | $762.02 |
- 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 |