- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,251.00 / $7,960.15
| Facility | | $1,965.00 | $4,251.00 | $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
- $753.80 / $1,020.47 / $9,251.00
| Facility | | $753.80 | $1,020.47 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $200.61 / $200.61 / $2,550.66
| Facility | AS | $200.61 | $200.61 | $2,550.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $6,787.00 / $11,396.00
| Facility | | $5,315.00 | $6,787.00 | $11,396.00 |