- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- 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
- $917.98 / $1,247.07 / $6,966.00
| Facility | | $917.98 | $1,247.07 | $6,966.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $243.32 / $243.32 / $440.52
| Facility | AS | $243.32 | $243.32 | $440.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,455.00 / $9,010.00
| Facility | | $4,613.00 | $6,455.00 | $9,010.00 |