- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.16 / $7,686.00 / $7,993.00
| Facility | | $1,528.16 | $7,686.00 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.16 / $1,994.75 / $2,921.08
| Facility | | $1,528.16 | $1,994.75 | $2,921.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $278.98 / $279.27 / $504.90
| Facility | AS | $278.98 | $279.27 | $504.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,892.40 / $8,892.40
| Facility | | $55.00 | $8,892.40 | $8,892.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $349.21 / $392.34 / $770.08
| Facility | AS | $349.21 | $392.34 | $770.08 |