- 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
- $2,060.59 / $2,909.06 / $5,223.21
| Facility | | $2,060.59 | $2,909.06 | $5,223.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $660.70 / $1,279.93 / $1,279.93
| Facility | AS | $660.70 | $1,279.93 | $1,279.93 |
- 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 |