- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $4,005.00 / $7,960.15
| Facility | | $1,070.00 | $4,005.00 | $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
- $503.17 / $673.34 / $3,790.00
| Facility | | $503.17 | $673.34 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $137.22 / $137.22 / $849.00
| Facility | AS | $137.22 | $137.22 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |