- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,000.00 / $3,890.45
| Facility | | $426.58 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,715.19 / $11,220.18
| Facility | | $5,888.44 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $724.44
| Facility | | $407.38 | $562.34 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $776.25 / $776.25
| Facility | | $34.67 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |