- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.23 / $3,940.00 / $7,602.00
| Facility | | $2,232.23 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,324.00 / $4,528.00
| Facility | | $1,275.00 | $2,324.00 | $4,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $25,619.52 / $26,184.36
| Facility | | $55.00 | $25,619.52 | $26,184.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $453.31 / $913.46 / $913.46
| Facility | AS | $453.31 | $913.46 | $913.46 |
- 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 |