- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,437.00 / $4,005.00 / $7,562.14
| Facility | | $1,437.00 | $4,005.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.55 / $853.17 / $9,251.00
| Facility | | $640.55 | $853.17 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.12 / $171.12 / $1,887.52
| Facility | AS | $171.12 | $171.12 | $1,887.52 |
- 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 |