- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,977.93 / $3,617.00 / $7,133.00
| Facility | | $1,977.93 | $3,617.00 | $7,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,377.49 / $5,113.62
| Facility | | $830.45 | $3,377.49 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.91 / $1,364.78 / $9,251.00
| Facility | | $971.91 | $1,364.78 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.80 / $258.80 / $1,887.52
| Facility | AS | $258.80 | $258.80 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |