- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $7,467.00
| Facility | | $1,671.00 | $3,437.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,626.12 / $4,140.09
| Facility | | $672.35 | $2,626.12 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.80 / $1,461.56 / $7,920.00
| Facility | | $1,088.80 | $1,461.56 | $7,920.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $298.26 / $298.26 / $1,442.13
| Facility | AS | $298.26 | $298.26 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $13,500.00
| Facility | | $4,637.00 | $6,477.00 | $13,500.00 |