- 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
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.82 / $2,161.67 / $4,345.06
| Facility | | $1,662.82 | $2,161.67 | $4,345.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $453.31 / $877.86 / $877.86
| Facility | AS | $453.31 | $877.86 | $877.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |