- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $8,104.00
| Facility | | $1,965.00 | $4,521.00 | $8,104.00 |
- 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
- $1,198.83 / $1,588.63 / $8,317.00
| Facility | | $1,198.83 | $1,588.63 | $8,317.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $317.08 / $317.08 / $575.25
| Facility | AS | $317.08 | $317.08 | $575.25 |
- 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 |