- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,873.00 / $9,196.00
| Facility | | $1,965.00 | $4,873.00 | $9,196.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,934.39 / $8,070.83
| Facility | | $1,310.70 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.33 / $1,273.80 / $7,167.00
| Facility | | $940.33 | $1,273.80 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.83 / $249.83 / $1,887.52
| Facility | AS | $249.83 | $249.83 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |