- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $5,055.00 / $10,407.00
| Facility | | $1,965.00 | $5,055.00 | $10,407.00 |
- 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
- $1,514.97 / $2,064.37 / $15,169.00
| Facility | | $1,514.97 | $2,064.37 | $15,169.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $414.08 / $414.08 / $764.78
| Facility | AS | $414.08 | $414.08 | $764.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,316.00 / $16,841.00
| Facility | | $3,560.00 | $10,316.00 | $16,841.00 |