- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,029.41 / $4,182.00 / $7,960.15
| Facility | | $2,029.41 | $4,182.00 | $7,960.15 |
- 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
- $999.71 / $1,409.37 / $9,251.00
| Facility | | $999.71 | $1,409.37 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.95 / $265.95 / $2,460.76
| Facility | AS | $265.95 | $265.95 | $2,460.76 |
- 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 |