- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $6,329.00
| Facility | | $1,671.00 | $3,819.00 | $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
- $1,829.76 / $2,439.64 / $15,470.00
| Facility | | $1,829.76 | $2,439.64 | $15,470.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $476.09 / $476.09 / $919.64
| Facility | AS | $476.09 | $476.09 | $919.64 |
- 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 |