- 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
- $1,762.00 / $3,161.00 / $5,923.91
| Facility | | $1,762.00 | $3,161.00 | $5,923.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $653.63 / $653.63 / $1,216.66
| Facility | AS | $653.63 | $653.63 | $1,216.66 |
- 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 |