- 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
- $1,715.00 / $2,399.35 / $4,468.67
| Facility | | $1,715.00 | $2,399.35 | $4,468.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $486.56 / $486.56 / $904.66
| Facility | AS | $486.56 | $486.56 | $904.66 |
- 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 |