- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.09 / $4,927.00 / $10,391.21
| Facility | | $1,337.09 | $4,927.00 | $10,391.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,881.00 / $18,409.41 / $42,190.00
| Facility | | $7,881.00 | $18,409.41 | $42,190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $1,260.22 / $1,260.22
| Facility | | $900.00 | $1,260.22 | $1,260.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.78 / $124.78 / $124.78
| Facility | AS | $124.78 | $124.78 | $124.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,705.00
| Facility | | $3,028.00 | $7,457.00 | $14,705.00 |