- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,840.00 / $9,429.00
| Facility | | $2,073.00 | $4,840.00 | $9,429.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.10 / $1,760.69 / $4,337.00
| Facility | | $1,271.10 | $1,760.69 | $4,337.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $341.72 / $606.13 / $606.13
| Facility | AS | $341.72 | $606.13 | $606.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |