- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $7,960.15
| Facility | | $1,671.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.94 / $1,492.98 / $3,047.63
| Facility | | $1,054.94 | $1,492.98 | $3,047.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.68 / $614.61 / $614.61
| Facility | AS | $331.68 | $614.61 | $614.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |