- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,192.00 / $13,200.00
| Facility | | $1,300.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.19 / $3,224.30 / $5,131.02
| Facility | | $2,044.19 | $3,224.30 | $5,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.32 / $1,882.00 / $7,214.89
| Facility | | $668.32 | $1,882.00 | $7,214.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $757.42 / $757.42 / $757.42
| Facility | AS | $757.42 | $757.42 | $757.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.00 / $4,054.00 / $7,077.94
| Facility | | $1,091.00 | $4,054.00 | $7,077.94 |