- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.25 / $2,973.00 / $10,233.62
| Facility | | $977.25 | $2,973.00 | $10,233.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.65 / $1,399.13 / $14,063.00
| Facility | | $962.65 | $1,399.13 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.10 / $1,887.52 / $1,887.52
| Facility | AS | $234.10 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $8,072.00 / $14,587.03
| Facility | | $1,851.00 | $8,072.00 | $14,587.03 |