- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $9,196.00
| Facility | | $1,965.00 | $4,521.00 | $9,196.00 |
- 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
- $1,084.18 / $1,424.00 / $9,247.84
| Facility | | $1,084.18 | $1,424.00 | $9,247.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $287.33 / $287.33 / $520.29
| Facility | AS | $287.33 | $287.33 | $520.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |