- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,892.50 / $3,617.00 / $6,329.00
| Facility | | $1,892.50 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,613.46 / $4,140.09
| Facility | | $672.35 | $2,613.46 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.58 / $1,431.96 / $9,251.00
| Facility | | $1,076.58 | $1,431.96 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $288.45 / $288.45 / $2,489.91
| Facility | AS | $288.45 | $288.45 | $2,489.91 |
- 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 |