- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,970.84 / $6,060.00 / $9,196.00
| Facility | | $1,970.84 | $6,060.00 | $9,196.00 |
- 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
- $970.86 / $1,330.85 / $6,117.00
| Facility | | $970.86 | $1,330.85 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.23 / $464.74 / $464.74
| Facility | AS | $258.23 | $464.74 | $464.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |