- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,474.00 / $7,960.15
| Facility | | $1,965.00 | $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
- $1,787.13 / $2,155.62 / $4,349.00
| Facility | | $1,787.13 | $2,155.62 | $4,349.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $488.41 / $882.55 / $882.55
| Facility | AS | $488.41 | $882.55 | $882.55 |
- 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 |