- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.00 / $1,665.34 / $13,045.67
| Facility | | $1,194.00 | $1,665.34 | $13,045.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,565.00 / $6,410.00 / $14,034.00
| Facility | | $3,565.00 | $6,410.00 | $14,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.84 / $1,707.38 / $1,969.60
| Facility | | $1,250.84 | $1,707.38 | $1,969.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.26 / $1,503.07 / $1,503.07
| Facility | | $1,412.26 | $1,503.07 | $1,503.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.79 / $147.79 / $147.79
| Facility | AS | $147.79 | $147.79 | $147.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |