- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.50 / $4,521.00 / $8,717.00
| Facility | | $1,443.50 | $4,521.00 | $8,717.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,532.98 / $5,814.97
| Facility | | $944.35 | $3,532.98 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.16 / $1,046.98 / $9,383.00
| Facility | | $715.16 | $1,046.98 | $9,383.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.98 / $1,279.44 / $1,279.44
| Facility | AS | $190.98 | $1,279.44 | $1,279.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |