- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.48 / $4,521.00 / $9,196.00
| Facility | | $1,877.48 | $4,521.00 | $9,196.00 |
- 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
- $924.87 / $1,399.58 / $6,950.00
| Facility | | $924.87 | $1,399.58 | $6,950.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $244.72 / $244.72 / $443.85
| Facility | AS | $244.72 | $244.72 | $443.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,455.00 / $9,010.00
| Facility | | $4,613.00 | $6,455.00 | $9,010.00 |