- 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
- $1,029.69 / $1,461.18 / $2,981.17
| Facility | | $1,029.69 | $1,461.18 | $2,981.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $325.25 / $600.67 / $600.67
| Facility | AS | $325.25 | $600.67 | $600.67 |
- 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 |