- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.10 / $1,398.47 / $4,846.00
| Facility | | $1,261.10 | $1,398.47 | $4,846.00 |
- 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
- $1,165.39 / $1,515.01 / $1,748.09
| Facility | | $1,165.39 | $1,515.01 | $1,748.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,497.17
| Facility | | $761.00 | $761.00 | $1,497.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $146.97 / $146.97 / $146.97
| Facility | AS | $146.97 | $146.97 | $146.97 |
- 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 |