- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.50 / $4,251.00 / $7,133.00
| Facility | | $1,648.50 | $4,251.00 | $7,133.00 |
- 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
- $709.94 / $944.68 / $9,251.00
| Facility | | $709.94 | $944.68 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.15 / $189.15 / $5,333.89
| Facility | AS | $189.15 | $189.15 | $5,333.89 |
- 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 |