- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $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
- $1,112.65 / $1,408.20 / $2,773.15
| Facility | | $1,112.65 | $1,408.20 | $2,773.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $301.56 / $550.88 / $550.88
| Facility | AS | $301.56 | $550.88 | $550.88 |
- 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 |