- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.87 / $2,318.00 / $12,295.76
| Facility | | $920.87 | $2,318.00 | $12,295.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.00 / $7,572.00 / $18,942.00
| Facility | | $1,058.00 | $7,572.00 | $18,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.23 / $1,106.59 / $1,276.84
| Facility | | $851.23 | $1,106.59 | $1,276.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,095.64 / $2,513.90
| Facility | | $761.00 | $1,095.64 | $2,513.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.75 / $107.75 / $107.75
| Facility | AS | $107.75 | $107.75 | $107.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,000.00 / $14,061.00 / $19,962.00
| Facility | | $4,000.00 | $14,061.00 | $19,962.00 |