- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.06 / $4,521.00 / $10,689.00
| Facility | | $1,618.06 | $4,521.00 | $10,689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,977.00 / $16,827.83 / $55,752.34
| Facility | | $2,977.00 | $16,827.83 | $55,752.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $1,243.65 / $1,487.30
| Facility | | $950.00 | $1,243.65 | $1,487.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.38 / $147.38 / $147.38
| Facility | AS | $147.38 | $147.38 | $147.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $21,651.00
| Facility | | $4,505.00 | $10,133.00 | $21,651.00 |