- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $6,329.00
| Facility | | $1,671.00 | $3,819.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.18 / $2,415.07 / $4,552.88
| Facility | | $1,894.18 | $2,415.07 | $4,552.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $559.38 / $559.38 / $1,057.84
| Facility | AS | $559.38 | $559.38 | $1,057.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.00 / $2,336.00 / $6,416.00
| Facility | | $1,372.00 | $2,336.00 | $6,416.00 |