- 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
- $2,006.98 / $2,712.76 / $15,622.00
| Facility | | $2,006.98 | $2,712.76 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $520.80 / $520.80 / $967.18
| Facility | AS | $520.80 | $520.80 | $967.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,420.00 / $18,626.00
| Facility | | $3,560.00 | $10,420.00 | $18,626.00 |