- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.34 / $4,846.00 / $16,174.90
| Facility | | $1,050.34 | $4,846.00 | $16,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.54 / $1,321.50 / $1,524.81
| Facility | | $1,016.54 | $1,321.50 | $1,524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,309.66
| Facility | | $761.00 | $761.00 | $1,309.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.44 / $128.44 / $128.44
| Facility | AS | $128.44 | $128.44 | $128.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |