- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.00 / $3,940.00 / $10,234.00
| Facility | | $2,311.00 | $3,940.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,324.00 / $4,528.00
| Facility | | $1,275.00 | $2,324.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $32,520.64 / $33,301.12
| Facility | | $55.00 | $32,520.64 | $33,301.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $443.31 / $860.69 / $860.69
| Facility | AS | $443.31 | $860.69 | $860.69 |
- 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 |