- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.78 / $6,774.95 / $11,909.00
| Facility | | $1,246.78 | $6,774.95 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.92 / $10,380.37 / $19,132.41
| Facility | | $3,105.92 | $10,380.37 | $19,132.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $3,639.40 / $4,676.68
| Facility | | $715.00 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.82 / $1,055.32 / $1,939.98
| Facility | | $841.82 | $1,055.32 | $1,939.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.56 / $145.38 / $221.87
| Facility | AS | $119.56 | $145.38 | $221.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |