- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $7,960.15
| Facility | | $1,671.00 | $3,617.00 | $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
- $1,093.92 / $1,544.35 / $3,592.00
| Facility | | $1,093.92 | $1,544.35 | $3,592.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $344.38 / $638.23 / $638.23
| Facility | AS | $344.38 | $638.23 | $638.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.00 / $3,205.00 / $5,133.00
| Facility | | $845.00 | $3,205.00 | $5,133.00 |