- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,820.00 / $4,844.50 / $11,545.00
| Facility | | $1,820.00 | $4,844.50 | $11,545.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,364.00 / $26,162.00 / $59,586.31
| Facility | | $5,364.00 | $26,162.00 | $59,586.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,920.98 / $1,920.98
| Facility | | $1,000.00 | $1,920.98 | $1,920.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.33 / $190.33 / $190.33
| Facility | AS | $190.33 | $190.33 | $190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $21,600.00
| Facility | | $4,505.00 | $10,133.00 | $21,600.00 |