- 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
- $1,795.64 / $2,493.67 / $4,490.67
| Facility | | $1,795.64 | $2,493.67 | $4,490.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $568.48 / $1,101.15 / $1,101.15
| Facility | AS | $568.48 | $1,101.15 | $1,101.15 |
- 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 |