- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.12 / $3,617.00 / $6,305.00
| Facility | | $1,497.12 | $3,617.00 | $6,305.00 |
- 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
- $737.50 / $1,032.50 / $13,439.00
| Facility | | $737.50 | $1,032.50 | $13,439.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.46 / $191.46 / $354.84
| Facility | AS | $191.46 | $191.46 | $354.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,316.00 / $16,841.00
| Facility | | $3,560.00 | $10,316.00 | $16,841.00 |