- 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
- $951.78 / $1,274.46 / $6,967.74
| Facility | | $951.78 | $1,274.46 | $6,967.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.88 / $251.88 / $456.72
| Facility | AS | $251.88 | $251.88 | $456.72 |
- 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 |