- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.18 / $3,734.76 / $7,602.00
| Facility | | $2,015.18 | $3,734.76 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,326.00 / $4,147.00
| Facility | | $1,375.00 | $2,326.00 | $4,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $26,242.72 / $26,887.04
| Facility | | $55.00 | $26,242.72 | $26,887.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $357.95 / $697.18 / $697.18
| Facility | AS | $357.95 | $697.18 | $697.18 |
- 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 |