- 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
- $1,116.24 / $1,562.86 / $14,190.57
| Facility | | $1,116.24 | $1,562.86 | $14,190.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $336.38 / $336.38 / $628.54
| Facility | AS | $336.38 | $336.38 | $628.54 |
- 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 |