- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $2,989.11 / $7,602.00
| Facility | | $2,258.00 | $2,989.11 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,302.00 / $4,372.00
| Facility | | $1,275.00 | $2,302.00 | $4,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,145.66 / $14,531.94
| Facility | | $55.00 | $14,145.66 | $14,531.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $340.59 / $657.10 / $657.10
| Facility | AS | $340.59 | $657.10 | $657.10 |
- 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 |