- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.30 / $4,474.00 / $7,960.15
| Facility | | $1,171.30 | $4,474.00 | $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
- $429.61 / $612.41 / $3,339.00
| Facility | | $429.61 | $612.41 | $3,339.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.49 / $196.49 / $196.49
| Facility | AS | $196.49 | $196.49 | $196.49 |
- 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 |