- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $5,906.08 / $76,602.70
| Facility | | $1,965.00 | $5,906.08 | $76,602.70 |
- 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 / $3,636.75 / $6,416.00
| Facility | | $1,778.00 | $3,636.75 | $6,416.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $750.85 / $750.85 / $1,399.83
| Facility | AS | $750.85 | $750.85 | $1,399.83 |
- 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 |