- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,827.51 / $3,386.95 / $7,602.00
| Facility | | $1,827.51 | $3,386.95 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,387.00 / $5,588.00
| Facility | | $1,375.00 | $2,387.00 | $5,588.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $23,770.56 / $24,358.88
| Facility | | $55.00 | $23,770.56 | $24,358.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.94 / $630.82 / $630.82
| Facility | AS | $323.94 | $630.82 | $630.82 |
- 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 |