- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.24 / $4,474.00 / $8,326.00
| Facility | | $1,439.24 | $4,474.00 | $8,326.00 |
- 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
- $707.22 / $930.03 / $9,437.00
| Facility | | $707.22 | $930.03 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.06 / $184.06 / $342.12
| Facility | AS | $184.06 | $184.06 | $342.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,457.00 / $11,396.00
| Facility | | $5,315.00 | $7,457.00 | $11,396.00 |