- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $7,562.14
| Facility | | $1,671.00 | $3,819.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $6,640.00 / $10,860.55
| Facility | | $1,805.25 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.00 / $2,823.91 / $5,211.39
| Facility | | $1,778.00 | $2,823.91 | $5,211.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $572.25 / $572.25 / $1,064.82
| Facility | AS | $572.25 | $572.25 | $1,064.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $6,416.00
| Facility | | $1,424.00 | $3,269.00 | $6,416.00 |