- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $6,329.00
| Facility | | $1,671.00 | $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
- $979.37 / $1,390.58 / $9,437.00
| Facility | | $979.37 | $1,390.58 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.56 / $477.61 / $477.61
| Facility | AS | $258.56 | $477.61 | $477.61 |
- 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 |