- 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
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,535.73 / $2,052.17 / $9,437.00
| Facility | | $1,535.73 | $2,052.17 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.97 / $402.97 / $770.53
| Facility | AS | $402.97 | $402.97 | $770.53 |
- 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 |