- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,873.00 / $9,618.00
| Facility | | $1,671.00 | $4,873.00 | $9,618.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.57 / $977.53 / $7,167.00
| Facility | | $719.57 | $977.53 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.36 / $191.36 / $1,887.52
| Facility | AS | $191.36 | $191.36 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,759.00 / $6,477.00 / $9,010.00
| Facility | | $4,759.00 | $6,477.00 | $9,010.00 |