- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,944.86 / $3,870.57 / $7,134.00
| Facility | | $1,944.86 | $3,870.57 | $7,134.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.16 / $775.40 / $969.26
| Facility | | $646.16 | $775.40 | $969.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.62 / $772.62 / $772.62
| Facility | | $772.62 | $772.62 | $772.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.76 / $76.76 / $76.76
| Facility | AS | $76.76 | $76.76 | $76.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.80 / $5,676.25 / $19,708.52
| Facility | | $1,902.80 | $5,676.25 | $19,708.52 |