- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,545.72 / $10,234.00
| Facility | | $2,258.00 | $3,545.72 | $10,234.00 |
- 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 / $24,133.60 / $24,707.52
| Facility | | $55.00 | $24,133.60 | $24,707.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $329.50 / $641.54 / $641.54
| Facility | AS | $329.50 | $641.54 | $641.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |