- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.14 / $4,474.00 / $8,239.00
| Facility | | $1,946.14 | $4,474.00 | $8,239.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.69 / $1,271.58 / $9,251.00
| Facility | | $958.69 | $1,271.58 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $254.28 / $4,740.35
| Facility | AS | $254.28 | $254.28 | $4,740.35 |
- 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 |