- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $3,770.00 / $7,467.00
| Facility | | $1,965.00 | $3,770.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $5,330.69 / $8,174.14
| Facility | | $1,310.70 | $5,330.69 | $8,174.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.93 / $1,440.66 / $9,437.00
| Facility | | $1,056.93 | $1,440.66 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.33 / $272.33 / $1,887.52
| Facility | AS | $272.33 | $272.33 | $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 |