- 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
- $997.13 / $1,233.56 / $2,461.11
| Facility | | $997.13 | $1,233.56 | $2,461.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $273.12 / $492.14 / $492.14
| Facility | AS | $273.12 | $492.14 | $492.14 |
- 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 |