- 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
- $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
- $641.64 / $891.49 / $3,787.00
| Facility | | $641.64 | $891.49 | $3,787.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.01 / $182.01 / $736.98
| Facility | AS | $182.01 | $182.01 | $736.98 |
- 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 |