- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,960.15
| Facility | | $1,965.00 | $4,521.00 | $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
- $963.61 / $1,253.57 / $2,549.46
| Facility | | $963.61 | $1,253.57 | $2,549.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $278.39 / $515.76 / $515.76
| Facility | AS | $278.39 | $515.76 | $515.76 |
- 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 |