- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,678.00 / $7,602.00
| Facility | | $1,821.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,387.00 / $5,611.00
| Facility | | $1,375.00 | $2,387.00 | $5,611.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $15,934.72 / $16,316.96
| Facility | | $55.00 | $15,934.72 | $16,316.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $217.68 / $425.63 / $425.63
| Facility | AS | $217.68 | $425.63 | $425.63 |
- 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 |