- 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
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.11 / $1,692.51 / $4,199.00
| Facility | | $1,266.11 | $1,692.51 | $4,199.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $345.39 / $621.57 / $621.57
| Facility | AS | $345.39 | $621.57 | $621.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |