- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.33 / $5,211.12 / $14,989.11
| Facility | | $1,779.33 | $5,211.12 | $14,989.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $11,780.00 / $27,276.00
| Facility | | $4,755.00 | $11,780.00 | $27,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $1,780.07 / $1,780.07
| Facility | | $950.00 | $1,780.07 | $1,780.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.68 / $176.68 / $176.68
| Facility | AS | $176.68 | $176.68 | $176.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,317.00 / $20,361.00
| Facility | | $4,505.00 | $10,317.00 | $20,361.00 |