- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,033.91 / $2,683.00 / $7,602.00
| Facility | | $2,033.91 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,387.00 / $4,372.00
| Facility | | $1,375.00 | $2,387.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $22,482.88 / $23,059.04
| Facility | | $55.00 | $22,482.88 | $23,059.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $304.58 / $588.14 / $588.14
| Facility | AS | $304.58 | $588.14 | $588.14 |
- 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 |