- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,817.50 / $4,904.74 / $10,150.00
| Facility | | $1,817.50 | $4,904.74 | $10,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $7,312.30 / $11,504.39
| Facility | | $1,763.75 | $7,312.30 | $11,504.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.79 / $2,118.94 / $9,978.00
| Facility | | $1,543.79 | $2,118.94 | $9,978.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.38 / $398.38 / $7,529.59
| Facility | AS | $398.38 | $398.38 | $7,529.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |