- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.23 / $4,804.00 / $11,170.50
| Facility | | $1,794.23 | $4,804.00 | $11,170.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,157.00 / $21,256.00 / $55,752.34
| Facility | | $5,157.00 | $21,256.00 | $55,752.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,815.20 / $1,815.20
| Facility | | $1,000.00 | $1,815.20 | $1,815.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.56 / $180.56 / $180.56
| Facility | AS | $180.56 | $180.56 | $180.56 |
- 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 |