- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,960.15
| Facility | | $1,965.00 | $4,521.00 | $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
- $788.35 / $1,049.68 / $6,063.00
| Facility | | $788.35 | $1,049.68 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.68 / $209.68 / $2,392.36
| Facility | AS | $209.68 | $209.68 | $2,392.36 |
- 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 |