- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- 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
- $955.33 / $1,337.46 / $4,276.00
| Facility | | $955.33 | $1,337.46 | $4,276.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.77 / $459.14 / $459.14
| Facility | AS | $249.77 | $459.14 | $459.14 |
- 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 |