- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.60 / $7,134.00 / $18,603.54
| Facility | | $3,228.60 | $7,134.00 | $18,603.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.24 / $914.69 / $1,143.48
| Facility | | $762.24 | $914.69 | $1,143.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.77 / $944.77 / $944.77
| Facility | | $944.77 | $944.77 | $944.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.40 / $94.40 / $94.40
| Facility | AS | $94.40 | $94.40 | $94.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,093.29 / $11,684.75 / $15,404.21
| Facility | | $4,093.29 | $11,684.75 | $15,404.21 |