- 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
- $1,247.65 / $1,637.61 / $15,470.00
| Facility | | $1,247.65 | $1,637.61 | $15,470.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $322.06 / $322.06 / $602.19
| Facility | AS | $322.06 | $322.06 | $602.19 |
- 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 |