- 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
- $1,233.59 / $4,605.95 / $8,070.83
| Facility | | $1,233.59 | $4,605.95 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.04 / $1,193.86 / $2,352.41
| Facility | | $965.04 | $1,193.86 | $2,352.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.58 / $478.82 / $478.82
| Facility | AS | $258.58 | $478.82 | $478.82 |
- 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 |