- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $7,960.15
| Facility | | $1,671.00 | $4,474.00 | $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
- $1,943.00 / $2,709.73 / $4,824.51
| Facility | | $1,943.00 | $2,709.73 | $4,824.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $608.09 / $1,179.57 / $1,179.57
| Facility | AS | $608.09 | $1,179.57 | $1,179.57 |
- 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 |