- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,960.15
| Facility | | $1,965.00 | $4,521.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.90 / $1,500.60 / $6,950.00
| Facility | | $1,136.90 | $1,500.60 | $6,950.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.12 / $302.12 / $546.94
| Facility | AS | $302.12 | $302.12 | $546.94 |
- 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 |