- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $9,196.00
| Facility | | $1,671.00 | $4,521.00 | $9,196.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,670.74 / $5,814.97
| Facility | | $944.35 | $3,670.74 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.27 / $945.71 / $9,251.00
| Facility | | $674.27 | $945.71 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.43 / $201.43 / $2,446.92
| Facility | AS | $201.43 | $201.43 | $2,446.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |