- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,632.00 / $7,960.15
| Facility | | $2,073.00 | $4,632.00 | $7,960.15 |
- 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
- $1,132.08 / $1,499.86 / $9,249.00
| Facility | | $1,132.08 | $1,499.86 | $9,249.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $300.10 / $300.10 / $543.30
| Facility | AS | $300.10 | $300.10 | $543.30 |
- 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 |