- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.20 / $2,747.00 / $9,128.46
| Facility | | $758.20 | $2,747.00 | $9,128.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $10,301.00
| Facility | | $2,088.00 | $3,967.00 | $10,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.27 / $930.51 / $1,137.30
| Facility | | $689.27 | $930.51 | $1,137.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.76 / $847.76 / $952.91
| Facility | | $847.76 | $847.76 | $952.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.37 / $84.37 / $84.37
| Facility | AS | $84.37 | $84.37 | $84.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |