- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,965.25 / $7,602.00
| Facility | | $1,821.00 | $2,965.25 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,744.00 / $9,265.00 / $16,372.00
| Facility | | $3,744.00 | $9,265.00 | $16,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $19,012.91 / $19,717.20
| Facility | | $55.00 | $19,012.91 | $19,717.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.10 / $680.24 / $680.24
| Facility | AS | $338.10 | $680.24 | $680.24 |
- 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 |