- 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
- $927.23 / $1,168.51 / $2,301.57
| Facility | | $927.23 | $1,168.51 | $2,301.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.72 / $458.54 / $458.54
| Facility | AS | $251.72 | $458.54 | $458.54 |
- 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 |