- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,774.17 / $6,060.00 / $11,109.00
| Facility | | $1,774.17 | $6,060.00 | $11,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $4,903.56 / $8,070.83
| Facility | | $1,310.70 | $4,903.56 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,269.46 / $5,269.46 / $5,269.46
| Facility | | $5,269.46 | $5,269.46 | $5,269.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.81 / $1,223.57 / $9,383.00
| Facility | | $880.81 | $1,223.57 | $9,383.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.52 / $1,537.78 / $1,537.78
| Facility | AS | $230.52 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |