- 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
- $1,310.70 / $4,934.39 / $8,070.83
| Facility | | $1,310.70 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.17 / $1,523.45 / $9,712.00
| Facility | | $1,185.17 | $1,523.45 | $9,712.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $301.38 / $301.38 / $1,887.52
| Facility | AS | $301.38 | $301.38 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,499.00 / $11,396.00
| Facility | | $5,279.00 | $7,499.00 | $11,396.00 |