- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.05 / $2,002.83 / $8,229.00
| Facility | | $1,742.05 | $2,002.83 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.17 / $2,549.05 / $2,940.52
| Facility | | $1,857.17 | $2,549.05 | $2,940.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.56 / $2,233.56 / $2,233.56
| Facility | | $2,233.56 | $2,233.56 | $2,233.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.00 / $219.00 / $219.00
| Facility | AS | $219.00 | $219.00 | $219.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |