- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.24 / $4,521.00 / $9,112.00
| Facility | | $1,252.24 | $4,521.00 | $9,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,934.39 / $8,070.83
| Facility | | $1,310.70 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.33 / $816.08 / $7,167.00
| Facility | | $615.33 | $816.08 | $7,167.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.08 / $165.08 / $2,608.31
| Facility | AS | $165.08 | $165.08 | $2,608.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |