- 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
- $955.82 / $1,204.57 / $2,364.91
| Facility | | $955.82 | $1,204.57 | $2,364.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.31 / $473.22 / $473.22
| Facility | AS | $258.31 | $473.22 | $473.22 |
- 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 |