- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.34 / $4,804.00 / $10,620.21
| Facility | | $1,712.34 | $4,804.00 | $10,620.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,273.00 / $24,163.00 / $64,338.00
| Facility | | $5,273.00 | $24,163.00 | $64,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,734.44 / $1,734.44
| Facility | | $1,000.00 | $1,734.44 | $1,734.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $172.62 / $172.62 / $172.62
| Facility | AS | $172.62 | $172.62 | $172.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $9,696.00 / $20,812.48
| Facility | | $3,800.00 | $9,696.00 | $20,812.48 |