- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $11,119.20
| Facility | | $1,671.00 | $3,617.00 | $11,119.20 |
- 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
- $1,715.90 / $2,258.08 / $4,435.00
| Facility | | $1,715.90 | $2,258.08 | $4,435.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $450.27 / $450.27 / $837.29
| Facility | AS | $450.27 | $450.27 | $837.29 |
- 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 |