- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- 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
- $846.63 / $1,150.15 / $13,439.00
| Facility | | $846.63 | $1,150.15 | $13,439.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $220.18 / $220.18 / $407.22
| Facility | AS | $220.18 | $220.18 | $407.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,419.00 / $10,420.00 / $18,626.00
| Facility | | $4,419.00 | $10,420.00 | $18,626.00 |