- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,470.00 / $8,953.07
| Facility | | $1,258.00 | $4,470.00 | $8,953.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,344.00 / $8,563.00
| Facility | | $2,114.00 | $4,344.00 | $8,563.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.07 / $1,231.30 / $19,067.25
| Facility | | $719.07 | $1,231.30 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $198.71 / $198.71 / $2,614.82
| Facility | AS | $198.71 | $198.71 | $2,614.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $10,781.00
| Facility | | $2,156.00 | $4,000.00 | $10,781.00 |