- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.10 / $1,278.67 / $4,846.00
| Facility | | $1,153.10 | $1,278.67 | $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
- $1,065.56 / $1,385.23 / $1,598.34
| Facility | | $1,065.56 | $1,385.23 | $1,598.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,363.66
| Facility | | $761.00 | $761.00 | $1,363.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.03 / $134.03 / $134.03
| Facility | AS | $134.03 | $134.03 | $134.03 |
- 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 |