- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.12 / $4,470.00 / $13,151.00
| Facility | | $1,322.12 | $4,470.00 | $13,151.00 |
- 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
- $1,044.73 / $1,703.04 / $26,542.00
| Facility | | $1,044.73 | $1,703.04 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $286.66 / $286.66 / $4,708.97
| Facility | AS | $286.66 | $286.66 | $4,708.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,463.00 / $12,989.00
| Facility | | $2,426.00 | $4,463.00 | $12,989.00 |