- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,856.08 / $2,678.00 / $7,602.00
| Facility | | $1,856.08 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,936.00
| Facility | | $1,275.00 | $2,326.00 | $4,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,476.00 / $21,076.48
| Facility | | $55.00 | $20,476.00 | $21,076.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $277.56 / $535.98 / $535.98
| Facility | AS | $277.56 | $535.98 | $535.98 |
- 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 |