- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,558.26 / $2,678.00 / $7,602.00
| Facility | | $1,558.26 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,936.00
| Facility | | $1,275.00 | $2,326.00 | $4,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $13,130.24 / $13,447.84
| Facility | | $55.00 | $13,130.24 | $13,447.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $179.71 / $352.23 / $352.23
| Facility | AS | $179.71 | $352.23 | $352.23 |
- 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 |