- 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
- $836.77 / $1,188.10 / $2,041.00
| Facility | | $836.77 | $1,188.10 | $2,041.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.27 / $218.27 / $408.43
| Facility | AS | $218.27 | $218.27 | $408.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |