- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.33 / $2,683.00 / $7,602.00
| Facility | | $1,951.33 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,302.00 / $4,528.00
| Facility | | $1,270.00 | $2,302.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $12,164.49 / $12,535.65
| Facility | | $55.00 | $12,164.49 | $12,535.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $292.98 / $565.58 / $565.58
| Facility | AS | $292.98 | $565.58 | $565.58 |
- 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 |