- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.82 / $3,437.00 / $6,329.00
| Facility | | $1,276.82 | $3,437.00 | $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
- $691.88 / $948.51 / $13,761.00
| Facility | | $691.88 | $948.51 | $13,761.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $164.22 / $302.45 / $302.45
| Facility | AS | $164.22 | $302.45 | $302.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,316.00 / $16,841.00
| Facility | | $3,560.00 | $10,316.00 | $16,841.00 |