- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,162.23 / $4,908.00 / $13,177.00
| Facility | | $2,162.23 | $4,908.00 | $13,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,517.00 / $19,069.00
| Facility | | $2,224.00 | $4,517.00 | $19,069.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,603.79 / $11,043.00
| Facility | | $55.00 | $2,603.79 | $11,043.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $501.58 / $933.88 / $933.88
| Facility | AS | $501.58 | $933.88 | $933.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $2,693.00 / $10,500.00
| Facility | | $1,367.00 | $2,693.00 | $10,500.00 |