- 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 / $3,839.43 / $7,079.64
| Facility | | $1,762.00 | $3,839.43 | $7,079.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $776.25 / $776.25 / $1,447.81
| Facility | AS | $776.25 | $776.25 | $1,447.81 |
- 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 |