- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.61 / $3,921.00 / $8,104.00
| Facility | | $1,130.61 | $3,921.00 | $8,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.58 / $779.74 / $3,978.00
| Facility | | $555.58 | $779.74 | $3,978.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.18 / $144.18 / $267.94
| Facility | AS | $144.18 | $144.18 | $267.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |