- 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 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.78 / $1,167.96 / $4,276.00
| Facility | | $875.78 | $1,167.96 | $4,276.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.45 / $233.45 / $439.31
| Facility | AS | $233.45 | $233.45 | $439.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $3,269.00 / $5,491.00
| Facility | | $1,519.00 | $3,269.00 | $5,491.00 |