- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,260.00 / $5,238.00 / $8,790.00
| Facility | | $2,260.00 | $5,238.00 | $8,790.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $7,312.30 / $11,806.75
| Facility | | $1,763.75 | $7,312.30 | $11,806.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.03 / $1,972.73 / $15,169.00
| Facility | | $1,489.03 | $1,972.73 | $15,169.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.58 / $380.58 / $722.70
| Facility | AS | $380.58 | $380.58 | $722.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,420.00 / $16,841.00
| Facility | | $3,560.00 | $10,420.00 | $16,841.00 |