- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,960.15
| Facility | | $1,671.00 | $3,617.00 | $7,960.15 |
- 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
- $649.08 / $804.14 / $3,592.00
| Facility | | $649.08 | $804.14 | $3,592.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.03 / $382.77 / $382.77
| Facility | AS | $175.03 | $382.77 | $382.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,311.00 / $5,133.00
| Facility | | $845.00 | $3,311.00 | $5,133.00 |