- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $7,960.15
| Facility | | $1,671.00 | $3,819.00 | $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
- $112.25 / $145.34 / $1,424.00
| Facility | | $112.25 | $145.34 | $1,424.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $29.27 / $54.19 / $54.19
| Facility | AS | $29.27 | $54.19 | $54.19 |
- 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 |