- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.27 / $3,758.00 / $6,329.00
| Facility | | $1,744.27 | $3,758.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.25 / $1,140.83 / $6,950.00
| Facility | | $859.25 | $1,140.83 | $6,950.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.46 / $227.46 / $412.36
| Facility | AS | $227.46 | $227.46 | $412.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |