- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.93 / $4,167.00 / $7,960.15
| Facility | | $1,352.93 | $4,167.00 | $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
- $666.30 / $883.02 / $6,063.00
| Facility | | $666.30 | $883.02 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.32 / $177.32 / $849.00
| Facility | AS | $177.32 | $177.32 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |