- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $8,336.54
| Facility | | $1,965.00 | $4,521.00 | $8,336.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.89 / $2,086.23 / $7,168.00
| Facility | | $1,576.89 | $2,086.23 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.83 / $416.83 / $756.76
| Facility | AS | $416.83 | $416.83 | $756.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |