- 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
- $1,225.96 / $1,789.59 / $4,435.00
| Facility | | $1,225.96 | $1,789.59 | $4,435.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $304.58 / $304.58 / $571.47
| Facility | AS | $304.58 | $304.58 | $571.47 |
- 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 |