- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.71 / $4,223.50 / $7,960.15
| Facility | | $1,271.71 | $4,223.50 | $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
- $626.46 / $830.82 / $6,063.00
| Facility | | $626.46 | $830.82 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $166.76 / $166.76 / $2,440.41
| Facility | AS | $166.76 | $166.76 | $2,440.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,021.00 / $4,545.00 / $7,217.00
| Facility | | $3,021.00 | $4,545.00 | $7,217.00 |