- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.00 / $4,474.00 / $7,960.15
| Facility | | $1,703.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $7,173.28 / $10,860.55
| Facility | | $1,763.75 | $7,173.28 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.29 / $1,526.58 / $9,712.00
| Facility | | $1,178.29 | $1,526.58 | $9,712.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.54 / $302.54 / $1,887.52
| Facility | AS | $302.54 | $302.54 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,499.00 / $11,396.00
| Facility | | $5,279.00 | $7,499.00 | $11,396.00 |