- 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
- $903.06 / $3,321.60 / $5,432.89
| Facility | | $903.06 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.00 / $1,070.86 / $4,337.00
| Facility | | $601.00 | $1,070.86 | $4,337.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.30 / $142.30 / $262.80
| Facility | AS | $142.30 | $142.30 | $262.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $6,416.00
| Facility | | $1,424.00 | $3,269.00 | $6,416.00 |