- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.45 / $3,940.00 / $7,602.00
| Facility | | $1,601.45 | $3,940.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,387.00 / $8,351.00
| Facility | | $1,375.00 | $2,387.00 | $8,351.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $10,929.04 / $11,173.12
| Facility | | $2,800.00 | $10,929.04 | $11,173.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $306.69 / $587.71 / $587.71
| Facility | AS | $306.69 | $587.71 | $587.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |