- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,964.50 / $4,119.50 / $7,721.13
| Facility | | $1,964.50 | $4,119.50 | $7,721.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.22 / $956.73 / $7,167.00
| Facility | | $719.22 | $956.73 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.63 / $191.63 / $2,474.92
| Facility | AS | $191.63 | $191.63 | $2,474.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |