- 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
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.01 / $1,918.86 / $9,437.00
| Facility | | $1,443.01 | $1,918.86 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $378.42 / $378.42 / $713.31
| Facility | AS | $378.42 | $378.42 | $713.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |