- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,521.00 / $14,617.50
| Facility | | $2,114.00 | $4,521.00 | $14,617.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,915.16 / $6,307.36
| Facility | | $944.35 | $3,915.16 | $6,307.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.17 / $1,531.76 / $15,501.00
| Facility | | $1,147.17 | $1,531.76 | $15,501.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $304.35 / $304.35 / $5,190.20
| Facility | AS | $304.35 | $304.35 | $5,190.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,510.00 / $11,462.00 / $18,640.00
| Facility | | $4,510.00 | $11,462.00 | $18,640.00 |