- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,710.57 / $4,251.00 / $7,562.14
| Facility | | $1,710.57 | $4,251.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,106.86 / $5,113.62
| Facility | | $830.45 | $3,106.86 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,269.46 / $5,269.46 / $5,269.46
| Facility | | $5,269.46 | $5,269.46 | $5,269.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.23 / $1,084.50 / $9,383.00
| Facility | | $834.23 | $1,084.50 | $9,383.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.66 / $1,537.78 / $1,537.78
| Facility | AS | $219.66 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |