- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,763.57 / $7,602.00
| Facility | | $1,821.00 | $2,763.57 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,450.00 / $5,616.00
| Facility | | $1,417.00 | $2,450.00 | $5,616.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $19,477.28 / $19,942.24
| Facility | | $55.00 | $19,477.28 | $19,942.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.95 / $518.83 / $518.83
| Facility | AS | $265.95 | $518.83 | $518.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,886.00 / $20,054.00
| Facility | | $5,052.00 | $10,886.00 | $20,054.00 |