- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.51 / $1,278.83 / $5,749.75
| Facility | | $909.51 | $1,278.83 | $5,749.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.78 / $194.78 / $490.02
| Facility | AS | $194.78 | $194.78 | $490.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |