- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.92 / $4,474.00 / $8,239.00
| Facility | | $1,679.92 | $4,474.00 | $8,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.55 / $1,099.70 / $9,251.00
| Facility | | $827.55 | $1,099.70 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.82 / $219.82 / $4,720.97
| Facility | AS | $219.82 | $219.82 | $4,720.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $8,241.00 / $12,037.71
| Facility | | $5,315.00 | $8,241.00 | $12,037.71 |