- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.02 / $1,135.48 / $9,311.00
| Facility | | $889.02 | $1,135.48 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.77 / $1,202.04 / $1,386.64
| Facility | | $875.77 | $1,202.04 | $1,386.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.52 / $1,051.52 / $1,051.52
| Facility | | $1,051.52 | $1,051.52 | $1,051.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Facility | AS | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.00 / $1,121.00 / $8,582.00
| Facility | | $631.00 | $1,121.00 | $8,582.00 |