- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $5,389.00 / $9,823.00
| Facility | | $1,760.00 | $5,389.00 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $14,717.03
| Facility | | $2,224.00 | $4,490.00 | $14,717.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.50 / $2,343.73 / $4,784.56
| Facility | | $1,390.50 | $2,343.73 | $4,784.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.83 / $416.83 / $756.76
| Facility | AS | $416.83 | $416.83 | $756.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.30 / $4,000.00 / $9,817.00
| Facility | | $1,433.30 | $4,000.00 | $9,817.00 |