- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,819.00 / $7,960.15
| Facility | | $1,671.00 | $3,819.00 | $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
- $1,812.86 / $2,214.38 / $4,368.21
| Facility | | $1,812.86 | $2,214.38 | $4,368.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $518.05 / $950.53 / $950.53
| Facility | AS | $518.05 | $950.53 | $950.53 |
- 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 |