- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,521.00 / $7,960.15
| Facility | | $2,073.00 | $4,521.00 | $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
- $1,515.23 / $1,874.51 / $3,774.95
| Facility | | $1,515.23 | $1,874.51 | $3,774.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $408.74 / $750.25 / $750.25
| Facility | AS | $408.74 | $750.25 | $750.25 |
- 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 |