- 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
- $967.29 / $1,197.89 / $2,401.67
| Facility | | $967.29 | $1,197.89 | $2,401.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $259.83 / $479.42 / $479.42
| Facility | AS | $259.83 | $479.42 | $479.42 |
- 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 |