- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.86 / $2,678.00 / $7,602.00
| Facility | | $1,853.86 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.00 / $2,388.00 / $6,366.00
| Facility | | $1,428.00 | $2,388.00 | $6,366.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,104.64 / $14,512.08
| Facility | | $55.00 | $14,104.64 | $14,512.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $278.05 / $536.77 / $536.77
| Facility | AS | $278.05 | $536.77 | $536.77 |
- 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 |