- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,632.00 / $7,960.15
| Facility | | $2,073.00 | $4,632.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,555.20 / $5,814.97
| Facility | | $944.35 | $3,555.20 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $1,627.49 / $7,206.24
| Facility | | $1,230.00 | $1,627.49 | $7,206.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $327.41 / $327.41 / $2,419.88
| Facility | AS | $327.41 | $327.41 | $2,419.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |