- 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 / $2,326.00 / $4,372.00
| Facility | | $1,275.00 | $2,326.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $39,231.96 / $40,195.07
| Facility | | $55.00 | $39,231.96 | $40,195.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $450.27 / $873.75 / $873.75
| Facility | AS | $450.27 | $873.75 | $873.75 |
- 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 |