- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.76 / $2,678.00 / $7,602.00
| Facility | | $1,708.76 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,372.00
| Facility | | $1,275.00 | $2,326.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,364.64 / $14,685.28
| Facility | | $55.00 | $14,364.64 | $14,685.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.47 / $384.65 / $384.65
| Facility | AS | $196.47 | $384.65 | $384.65 |
- 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 |