- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,678.00 / $7,602.00
| Facility | | $1,821.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,302.00 / $4,936.00
| Facility | | $1,275.00 | $2,302.00 | $4,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,754.88 / $18,166.24
| Facility | | $55.00 | $17,754.88 | $18,166.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.76 / $474.32 / $474.32
| Facility | AS | $242.76 | $474.32 | $474.32 |
- 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 |