- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,708.12 / $4,384.00 / $7,960.15
| Facility | | $1,708.12 | $4,384.00 | $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
- $841.44 / $1,119.60 / $9,249.00
| Facility | | $841.44 | $1,119.60 | $9,249.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.93 / $223.93 / $2,497.23
| Facility | AS | $223.93 | $223.93 | $2,497.23 |
- 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 |