- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.93 / $2,678.00 / $7,602.00
| Facility | | $1,560.93 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,344.00 / $4,235.00
| Facility | | $1,375.00 | $2,344.00 | $4,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,007.75 / $8,231.12
| Facility | | $55.00 | $8,007.75 | $8,231.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.08 / $373.40 / $373.40
| Facility | AS | $193.08 | $373.40 | $373.40 |
- 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 |