- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $5,283.00 / $12,154.00
| Facility | | $1,547.00 | $5,283.00 | $12,154.00 |
- 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
- $1,011.48 / $1,649.84 / $26,542.00
| Facility | | $1,011.48 | $1,649.84 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.58 / $276.58 / $4,828.66
| Facility | AS | $276.58 | $276.58 | $4,828.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,432.00 / $12,989.00
| Facility | | $2,426.00 | $4,432.00 | $12,989.00 |