- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,678.00 / $7,602.00
| Facility | | $1,821.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.00 / $2,388.00 / $6,183.00
| Facility | | $1,428.00 | $2,388.00 | $6,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,645.56 / $10,934.28
| Facility | | $55.00 | $10,645.56 | $10,934.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $256.68 / $496.40 / $496.40
| Facility | AS | $256.68 | $496.40 | $496.40 |
- 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 |