- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.50 / $3,631.00 / $7,167.00
| Facility | | $1,548.50 | $3,631.00 | $7,167.00 |
- 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
- $5,750.38 / $5,750.38 / $5,750.38
| Facility | | $5,750.38 | $5,750.38 | $5,750.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.18 / $913.21 / $7,167.00
| Facility | | $666.18 | $913.21 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.57 / $1,678.13 / $1,678.13
| Facility | AS | $177.57 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,305.23 / $8,586.00
| Facility | | $4,637.00 | $6,305.23 | $8,586.00 |