- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,477.00 / $7,467.00
| Facility | | $1,965.00 | $3,477.00 | $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
- $1,517.50 / $2,012.45 / $3,911.00
| Facility | | $1,517.50 | $2,012.45 | $3,911.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.19 / $402.19 / $730.11
| Facility | AS | $402.19 | $402.19 | $730.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |