- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $6,640.00 / $10,860.55
| Facility | | $1,805.25 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.76 / $2,453.00 / $4,626.53
| Facility | | $1,656.76 | $2,453.00 | $4,626.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $501.58 / $501.58 / $933.88
| Facility | AS | $501.58 | $501.58 | $933.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.00 / $2,336.00 / $6,416.00
| Facility | | $1,360.00 | $2,336.00 | $6,416.00 |