- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.00 / $2,640.00 / $5,506.00
| Facility | | $1,162.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.91 / $239.68 / $5,580.00
| Facility | | $171.91 | $239.68 | $5,580.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.74 / $43.74 / $83.11
| Facility | AS | $43.74 | $43.74 | $83.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |