- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.50 / $3,617.00 / $6,841.77
| Facility | | $1,118.50 | $3,617.00 | $6,841.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.49 / $2,173.46 / $9,437.00
| Facility | | $1,649.49 | $2,173.46 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $429.59 / $429.59 / $812.47
| Facility | AS | $429.59 | $429.59 | $812.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |