- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $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
- $828.54 / $1,232.41 / $4,349.00
| Facility | | $828.54 | $1,232.41 | $4,349.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.53 / $362.41 / $362.41
| Facility | AS | $195.53 | $362.41 | $362.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |