- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.00 / $2,933.00 / $6,483.00
| Facility | | $1,582.00 | $2,933.00 | $6,483.00 |
- 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
- $830.88 / $1,161.19 / $6,063.00
| Facility | | $830.88 | $1,161.19 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $224.92 / $224.92 / $1,625.25
| Facility | AS | $224.92 | $224.92 | $1,625.25 |
- 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 |