- 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
- $1,754.33 / $2,517.77 / $4,686.01
| Facility | | $1,754.33 | $2,517.77 | $4,686.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $510.49 / $510.49 / $949.32
| Facility | AS | $510.49 | $510.49 | $949.32 |
- 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 |