- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,005.00 / $7,960.15
| Facility | | $2,073.00 | $4,005.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,377.49 / $5,113.62
| Facility | | $830.45 | $3,377.49 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.72 / $1,386.36 / $9,251.00
| Facility | | $953.72 | $1,386.36 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.07 / $254.07 / $1,887.52
| Facility | AS | $254.07 | $254.07 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |