- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.00 / $2,111.00 / $6,768.00
| Facility | | $1,293.00 | $2,111.00 | $6,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,424.51 / $10,227.10 / $15,653.51
| Facility | | $7,424.51 | $10,227.10 | $15,653.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.42 / $509.72 / $853.71
| Facility | | $381.42 | $509.72 | $853.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,917.45 / $6,100.00 / $11,050.00
| Facility | | $3,917.45 | $6,100.00 | $11,050.00 |