- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $5,389.00 / $12,237.00
| Facility | | $1,547.00 | $5,389.00 | $12,237.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.14 / $766.70 / $19,067.25
| Facility | | $467.14 | $766.70 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.72 / $130.72 / $1,887.52
| Facility | AS | $130.72 | $130.72 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.00 / $3,347.00 / $6,854.00
| Facility | | $1,708.00 | $3,347.00 | $6,854.00 |