- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.00 / $3,940.00 / $7,378.92
| Facility | | $1,517.00 | $3,940.00 | $7,378.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,753.00 / $5,959.00
| Facility | | $2,132.00 | $3,753.00 | $5,959.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,984.00 / $7,984.00
| Facility | | $55.00 | $7,984.00 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.83 / $757.42 / $757.42
| Facility | AS | $202.83 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,567.00 / $7,604.00
| Facility | | $2,426.00 | $4,567.00 | $7,604.00 |