- 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
- $725.61 / $994.66 / $7,041.00
| Facility | | $725.61 | $994.66 | $7,041.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.04 / $347.57 / $347.57
| Facility | AS | $193.04 | $347.57 | $347.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.00 / $6,455.00 / $9,010.00
| Facility | | $4,094.00 | $6,455.00 | $9,010.00 |