- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.50 / $4,873.00 / $11,109.00
| Facility | | $1,852.50 | $4,873.00 | $11,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.98 / $1,718.84 / $7,168.00
| Facility | | $1,262.98 | $1,718.84 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.24 / $1,324.34 / $1,324.34
| Facility | AS | $331.24 | $1,324.34 | $1,324.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $5,596.00 / $8,586.00
| Facility | | $4,637.00 | $5,596.00 | $8,586.00 |