- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $7,960.15
| Facility | | $1,671.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.40 / $3,100.51 / $5,432.89
| Facility | | $830.40 | $3,100.51 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.11 / $170.72 / $1,424.00
| Facility | | $132.11 | $170.72 | $1,424.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $34.09 / $63.58 / $63.58
| Facility | AS | $34.09 | $63.58 | $63.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |