- 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
- $1,275.00 / $2,302.00 / $4,528.00
| Facility | | $1,275.00 | $2,302.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,644.88 / $7,819.36
| Facility | | $55.00 | $7,644.88 | $7,819.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.17 / $412.05 / $412.05
| Facility | AS | $215.17 | $412.05 | $412.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |