- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,535.00 / $4,498.00 / $10,043.00
| Facility | | $1,535.00 | $4,498.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.84 / $1,070.16 / $8,957.00
| Facility | | $657.84 | $1,070.16 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.78 / $180.78 / $849.00
| Facility | AS | $180.78 | $180.78 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,306.00 / $3,071.00
| Facility | | $1,216.00 | $2,306.00 | $3,071.00 |