- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,713.16 / $6,112.00 / $11,906.04
| Facility | | $4,713.16 | $6,112.00 | $11,906.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.52 / $735.37 / $801.20
| Facility | | $660.52 | $735.37 | $801.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $709.00 / $709.00
| Facility | | $709.00 | $709.00 | $709.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.43 / $70.43 / $70.43
| Facility | AS | $70.43 | $70.43 | $70.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,831.58 / $11,932.92 / $17,426.41
| Facility | | $5,831.58 | $11,932.92 | $17,426.41 |