- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,083.98 / $3,940.00 / $7,920.26
| Facility | | $2,083.98 | $3,940.00 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.32 / $2,937.55 / $10,680.01
| Facility | | $1,603.32 | $2,937.55 | $10,680.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.14 / $2,268.14 / $5,170.58
| Facility | | $2,268.14 | $2,268.14 | $5,170.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $220.75 / $220.75 / $220.75
| Facility | AS | $220.75 | $220.75 | $220.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |