- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.16 / $2,683.00 / $7,602.00
| Facility | | $2,034.16 | $2,683.00 | $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 / $12,628.89 / $13,009.05
| Facility | | $55.00 | $12,628.89 | $13,009.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $304.80 / $590.55 / $590.55
| Facility | AS | $304.80 | $590.55 | $590.55 |
- 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 |