- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,819.00 / $7,467.00
| Facility | | $1,965.00 | $3,819.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.82 / $944.31 / $3,978.00
| Facility | | $672.82 | $944.31 | $3,978.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.87 / $174.87 / $324.41
| Facility | AS | $174.87 | $174.87 | $324.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,533.00 / $5,546.00
| Facility | | $2,132.00 | $3,533.00 | $5,546.00 |