- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $3,265.28 / $4,846.00
| Facility | | $2,318.00 | $3,265.28 | $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
- $2,721.07 / $3,537.39 / $4,081.61
| Facility | | $2,721.07 | $3,537.39 | $4,081.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $3,529.97
| Facility | | $761.00 | $761.00 | $3,529.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.01 / $346.01 / $346.01
| Facility | AS | $346.01 | $346.01 | $346.01 |
- 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 |