- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,641.50 / $7,467.00
| Facility | | $1,965.00 | $3,641.50 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.70 / $1,059.21 / $6,063.00
| Facility | | $790.70 | $1,059.21 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.82 / $210.82 / $2,396.92
| Facility | AS | $210.82 | $210.82 | $2,396.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,384.00 / $4,635.00 / $7,217.00
| Facility | | $3,384.00 | $4,635.00 | $7,217.00 |