- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.11 / $4,873.00 / $9,196.00
| Facility | | $1,755.11 | $4,873.00 | $9,196.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,941.68 / $4,941.68 / $4,941.68
| Facility | | $4,941.68 | $4,941.68 | $4,941.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.59 / $1,172.30 / $7,168.00
| Facility | | $864.59 | $1,172.30 | $7,168.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $225.48 / $1,442.13 / $1,442.13
| Facility | AS | $225.48 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,613.00 / $6,477.00 / $9,010.00
| Facility | | $4,613.00 | $6,477.00 | $9,010.00 |