- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,940.00 / $7,602.00
| Facility | | $2,258.00 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,387.00 / $4,827.00
| Facility | | $1,417.00 | $2,387.00 | $4,827.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $20,489.75 / $21,068.46
| Facility | | $55.00 | $20,489.75 | $21,068.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $507.12 / $982.36 / $982.36
| Facility | AS | $507.12 | $982.36 | $982.36 |
- 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 |