- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.57 / $6,460.61 / $11,821.25
| Facility | | $1,690.57 | $6,460.61 | $11,821.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,363.35 / $9,466.34
| Facility | | $2,000.00 | $2,363.35 | $9,466.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.00 / $1,944.16 / $3,448.36
| Facility | | $1,319.00 | $1,944.16 | $3,448.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.66 / $281.87 / $418.52
| Facility | AS | $184.66 | $281.87 | $418.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,973.00
| Facility | | $659.00 | $6,107.00 | $8,973.00 |