- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.65 / $4,261.00 / $11,094.00
| Facility | | $868.65 | $4,261.00 | $11,094.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $4,517.00 / $20,057.00
| Facility | | $2,232.00 | $4,517.00 | $20,057.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.04 / $1,172.60 / $26,542.00
| Facility | | $706.04 | $1,172.60 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.92 / $187.92 / $5,298.50
| Facility | AS | $187.92 | $187.92 | $5,298.50 |
- 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 |