- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $12,023.81 / $17,946.48
| Facility | | $1,400.00 | $12,023.81 | $17,946.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.32 / $827.96 / $902.07
| Facility | | $741.32 | $827.96 | $902.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.14 / $798.14 / $798.14
| Facility | | $798.14 | $798.14 | $798.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.55 / $78.55 / $78.55
| Facility | AS | $78.55 | $78.55 | $78.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,767.17 / $5,767.17 / $47,665.82
| Facility | | $5,767.17 | $5,767.17 | $47,665.82 |