- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.05 / $3,131.00 / $9,304.00
| Facility | | $1,270.05 | $3,131.00 | $9,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $10,123.00
| Facility | | $2,224.00 | $4,490.00 | $10,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,960.15 / $9,837.00
| Facility | | $55.00 | $1,960.15 | $9,837.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $253.41 / $475.34 / $475.34
| Facility | AS | $253.41 | $475.34 | $475.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |