- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $5,455.00 / $14,853.00
| Facility | | $2,073.00 | $5,455.00 | $14,853.00 |
- 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
- $1,082.73 / $1,437.96 / $9,249.00
| Facility | | $1,082.73 | $1,437.96 | $9,249.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $287.61 / $287.61 / $520.90
| Facility | AS | $287.61 | $287.61 | $520.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |