- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,261.00 / $27,826.28
| Facility | | $1,258.00 | $4,261.00 | $27,826.28 |
- 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
- $840.57 / $1,376.43 / $21,310.46
| Facility | | $840.57 | $1,376.43 | $21,310.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.05 / $233.05 / $2,530.14
| Facility | AS | $233.05 | $233.05 | $2,530.14 |
- 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 |