- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.84 / $1,383.07 / $9,251.00
| Facility | | $1,040.84 | $1,383.07 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.79 / $276.79 / $4,839.43
| Facility | AS | $276.79 | $276.79 | $4,839.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $8,241.00 / $12,037.71
| Facility | | $5,315.00 | $8,241.00 | $12,037.71 |