- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,474.00 / $8,447.00
| Facility | | $2,073.00 | $4,474.00 | $8,447.00 |
- 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
- $1,135.55 / $1,499.26 / $6,117.00
| Facility | | $1,135.55 | $1,499.26 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $303.31 / $303.31 / $1,887.52
| Facility | AS | $303.31 | $303.31 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |