- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.29 / $5,946.00 / $18,600.00
| Facility | | $1,202.29 | $5,946.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,548.97 / $21,205.75
| Facility | | $8,723.84 | $13,548.97 | $21,205.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $8,274.00
| Facility | | $2,321.00 | $2,321.00 | $8,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.47 / $1,683.21 / $12,334.80
| Facility | | $1,106.47 | $1,683.21 | $12,334.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $502.13 / $502.13 / $502.13
| Facility | AS | $502.13 | $502.13 | $502.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $33,741.00
| Facility | | $1,851.00 | $7,307.00 | $33,741.00 |