- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.86 / $2,747.00 / $10,152.00
| Facility | | $849.86 | $2,747.00 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,486.00 / $12,157.00
| Facility | | $2,320.00 | $4,486.00 | $12,157.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.60 / $1,260.83 / $1,454.45
| Facility | | $918.60 | $1,260.83 | $1,454.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.54 / $1,112.54 / $1,112.54
| Facility | | $1,112.54 | $1,112.54 | $1,112.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.09 / $109.09 / $109.09
| Facility | AS | $109.09 | $109.09 | $109.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |