- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.00 / $5,886.99 / $31,554.55
| Facility | | $1,528.00 | $5,886.99 | $31,554.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.01 / $853.21 / $1,066.52
| Facility | | $711.01 | $853.21 | $1,066.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.76 / $847.76 / $847.76
| Facility | | $847.76 | $847.76 | $847.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.37 / $84.37 / $84.37
| Facility | AS | $84.37 | $84.37 | $84.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,670.80 / $23,499.33 / $42,863.19
| Facility | | $5,670.80 | $23,499.33 | $42,863.19 |