- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,521.00 / $10,407.00
| Facility | | $2,073.00 | $4,521.00 | $10,407.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $7,173.28 / $10,999.58
| Facility | | $1,763.75 | $7,173.28 | $10,999.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.44 / $1,721.16 / $15,622.00
| Facility | | $1,310.44 | $1,721.16 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $340.33 / $340.33 / $631.87
| Facility | AS | $340.33 | $340.33 | $631.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,420.00 / $18,626.00
| Facility | | $3,560.00 | $10,420.00 | $18,626.00 |