- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.80 / $4,005.00 / $7,960.15
| Facility | | $1,276.80 | $4,005.00 | $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
- $628.78 / $842.64 / $7,167.00
| Facility | | $628.78 | $842.64 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.58 / $168.58 / $2,515.96
| Facility | AS | $168.58 | $168.58 | $2,515.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |