- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $3,065.51 / $7,602.00
| Facility | | $1,821.00 | $3,065.51 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,344.00 / $4,235.00
| Facility | | $1,375.00 | $2,344.00 | $4,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,502.93 / $17,944.81
| Facility | | $55.00 | $17,502.93 | $17,944.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $293.72 / $572.38 / $572.38
| Facility | AS | $293.72 | $572.38 | $572.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,536.00 / $4,918.00
| Facility | | $1,200.00 | $2,536.00 | $4,918.00 |