- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $9,196.00
| Facility | | $1,671.00 | $4,521.00 | $9,196.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,555.20 / $5,814.97
| Facility | | $944.35 | $3,555.20 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.06 / $1,072.03 / $7,167.00
| Facility | | $791.06 | $1,072.03 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.47 / $210.47 / $1,887.52
| Facility | AS | $210.47 | $210.47 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |