- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.36 / $4,470.00 / $10,361.62
| Facility | | $1,327.36 | $4,470.00 | $10,361.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.96 / $1,514.21 / $26,542.00
| Facility | | $927.96 | $1,514.21 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $254.28 / $4,740.35
| Facility | AS | $254.28 | $254.28 | $4,740.35 |
- 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 |