- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,526.63 / $1,683.64 / $4,846.00
| Facility | | $1,526.63 | $1,683.64 | $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
- $1,403.03 / $1,823.94 / $2,104.55
| Facility | | $1,403.03 | $1,823.94 | $2,104.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,806.52
| Facility | | $761.00 | $761.00 | $1,806.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- 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 |