- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,960.15
| Facility | | $1,965.00 | $4,521.00 | $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
- $1,012.23 / $1,375.87 / $7,167.00
| Facility | | $1,012.23 | $1,375.87 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.13 / $1,324.34 / $1,324.34
| Facility | AS | $265.13 | $1,324.34 | $1,324.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,130.00 / $6,506.00 / $9,010.00
| Facility | | $4,130.00 | $6,506.00 | $9,010.00 |