- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.48 / $1,402.05 / $14,536.00
| Facility | | $1,043.48 | $1,402.05 | $14,536.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,632.00 / $4,714.00 / $10,301.00
| Facility | | $2,632.00 | $4,714.00 | $10,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.19 / $1,683.15 / $1,941.63
| Facility | | $1,240.19 | $1,683.15 | $1,941.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.26 / $1,484.26 / $1,732.79
| Facility | | $1,484.26 | $1,484.26 | $1,732.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.04 / $147.04 / $147.04
| Facility | AS | $147.04 | $147.04 | $147.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $6,444.00 / $12,296.00
| Facility | | $973.00 | $6,444.00 | $12,296.00 |