- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $8,326.00
| Facility | | $1,965.00 | $4,521.00 | $8,326.00 |
- 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
- $862.96 / $1,084.07 / $2,189.48
| Facility | | $862.96 | $1,084.07 | $2,189.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $231.37 / $428.11 / $428.11
| Facility | AS | $231.37 | $428.11 | $428.11 |
- 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 |