- 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
- $1,310.70 / $4,934.39 / $8,070.83
| Facility | | $1,310.70 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.12 / $1,370.46 / $9,214.92
| Facility | | $1,008.12 | $1,370.46 | $9,214.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.62 / $272.62 / $1,625.25
| Facility | AS | $272.62 | $272.62 | $1,625.25 |
- 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 |