- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.50 / $4,474.00 / $7,543.00
| Facility | | $1,484.50 | $4,474.00 | $7,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.35 / $2,717.00 / $4,087.07
| Facility | | $655.35 | $2,717.00 | $4,087.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.24 / $273.35 / $6,821.50
| Facility | | $211.24 | $273.35 | $6,821.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.77 / $55.77 / $105.67
| Facility | AS | $55.77 | $55.77 | $105.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,977.00 / $7,499.00
| Facility | | $1,078.00 | $1,977.00 | $7,499.00 |