- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $7,960.15
| Facility | | $1,671.00 | $3,437.00 | $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
- $77.25 / $99.65 / $902.00
| Facility | | $77.25 | $99.65 | $902.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.39 / $37.69 / $37.69
| Facility | AS | $20.39 | $37.69 | $37.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $1,423.00 / $2,114.00
| Facility | | $593.00 | $1,423.00 | $2,114.00 |