- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.71 / $3,038.06 / $16,467.00
| Facility | | $1,070.71 | $3,038.06 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,143.69 / $8,143.69 / $8,143.69
| Facility | | $8,143.69 | $8,143.69 | $8,143.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.71 / $1,455.00 / $2,499.71
| Facility | | $1,070.71 | $1,455.00 | $2,499.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.80 / $203.70 / $288.62
| Facility | AS | $184.80 | $203.70 | $288.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,818.00
| Facility | | $659.00 | $6,107.00 | $8,818.00 |