- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.79 / $4,182.00 / $7,960.15
| Facility | | $1,605.79 | $4,182.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $7,173.28 / $10,999.58
| Facility | | $1,763.75 | $7,173.28 | $10,999.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.03 / $1,063.78 / $9,437.00
| Facility | | $791.03 | $1,063.78 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.34 / $205.34 / $381.64
| Facility | AS | $205.34 | $205.34 | $381.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |