- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,126.91 / $3,641.50 / $6,864.00
| Facility | | $1,126.91 | $3,641.50 | $6,864.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.13 / $741.03 / $9,251.00
| Facility | | $555.13 | $741.03 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.13 / $148.13 / $2,455.55
| Facility | AS | $148.13 | $148.13 | $2,455.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |