- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,147.09 / $7,602.00
| Facility | | $2,258.00 | $3,147.09 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.00 / $2,388.00 / $6,217.00
| Facility | | $1,428.00 | $2,388.00 | $6,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $21,825.28 / $22,267.04
| Facility | | $55.00 | $21,825.28 | $22,267.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $298.16 / $582.35 / $582.35
| Facility | AS | $298.16 | $582.35 | $582.35 |
- 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 |