- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $9,112.00
| Facility | | $1,965.00 | $4,521.00 | $9,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.86 / $1,241.89 / $2,483.78
| Facility | | $1,003.86 | $1,241.89 | $2,483.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.12 / $497.90 / $497.90
| Facility | AS | $269.12 | $497.90 | $497.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |