- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.12 / $4,521.00 / $9,163.87
| Facility | | $2,056.12 | $4,521.00 | $9,163.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.59 / $4,605.95 / $8,070.83
| Facility | | $1,233.59 | $4,605.95 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.00 / $3,280.17 / $5,374.52
| Facility | | $995.00 | $3,280.17 | $5,374.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.87 / $1,277.22 / $6,230.00
| Facility | | $1,012.87 | $1,277.22 | $6,230.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $271.54 / $1,568.44 / $1,568.44
| Facility | AS | $271.54 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,350.00 / $6,230.00 / $9,010.00
| Facility | | $2,350.00 | $6,230.00 | $9,010.00 |