- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $5,002.93 / $19,870.00
| Facility | | $1,391.00 | $5,002.93 | $19,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,194.00 / $13,734.00
| Facility | | $3,512.00 | $7,194.00 | $13,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.00 / $27,770.10 / $27,770.10
| Facility | | $5,897.00 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $248.78 / $2,632.21 / $2,632.21
| Facility | AS | $248.78 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |