- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,678.23 / $7,602.00
| Facility | | $1,821.00 | $2,678.23 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,324.00 / $4,528.00
| Facility | | $1,275.00 | $2,324.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $18,886.40 / $19,297.91
| Facility | | $55.00 | $18,886.40 | $19,297.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.56 / $503.84 / $503.84
| Facility | AS | $258.56 | $503.84 | $503.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,273.00 / $12,407.00
| Facility | | $3,959.00 | $8,273.00 | $12,407.00 |