- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,437.00 / $6,329.00
| Facility | | $1,671.00 | $3,437.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.92 / $1,137.11 / $14,685.28
| Facility | | $830.92 | $1,137.11 | $14,685.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.47 / $363.47 / $363.47
| Facility | AS | $196.47 | $363.47 | $363.47 |
- 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 |