- 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
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.05 / $1,238.96 / $7,140.00
| Facility | | $928.05 | $1,238.96 | $7,140.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.71 / $245.71 / $445.36
| Facility | AS | $245.71 | $245.71 | $445.36 |
- 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 |