- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,002.50 / $4,119.50 / $7,960.15
| Facility | | $2,002.50 | $4,119.50 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,243.64 / $5,113.62
| Facility | | $830.45 | $3,243.64 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.41 / $843.30 / $9,251.00
| Facility | | $626.41 | $843.30 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $167.29 / $167.29 / $2,489.75
| Facility | AS | $167.29 | $167.29 | $2,489.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |