- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.07 / $1,086.54 / $2,747.00
| Facility | | $750.07 | $1,086.54 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,559.00 / $10,990.10 / $30,856.09
| Facility | | $6,559.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.51 / $1,160.98 / $1,339.27
| Facility | | $803.51 | $1,160.98 | $1,339.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,017.08 / $1,069.90
| Facility | | $1,017.08 | $1,017.08 | $1,069.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.81 / $100.81 / $100.81
| Facility | AS | $100.81 | $100.81 | $100.81 |
- 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 |