- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,470.00 / $12,154.00
| Facility | | $1,760.00 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $10,961.39
| Facility | | $2,224.00 | $4,490.00 | $10,961.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.00 / $2,705.45 / $7,903.00
| Facility | | $958.00 | $2,705.45 | $7,903.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $507.12 / $913.13 / $913.13
| Facility | AS | $507.12 | $913.13 | $913.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |