- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,776.00 / $7,562.14
| Facility | | $1,671.00 | $3,776.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.05 / $471.67 / $6,063.00
| Facility | | $260.05 | $471.67 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.72 / $78.72 / $1,887.52
| Facility | AS | $78.72 | $78.72 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |