- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,960.15
| Facility | | $1,965.00 | $4,521.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $4,903.56 / $8,070.83
| Facility | | $1,341.54 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.86 / $1,273.85 / $6,117.00
| Facility | | $818.86 | $1,273.85 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.81 / $193.81 / $757.42
| Facility | AS | $193.81 | $193.81 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |