- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.28 / $5,691.00 / $26,450.00
| Facility | | $1,807.28 | $5,691.00 | $26,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.00 / $6,018.00 / $20,396.50
| Facility | | $2,340.00 | $6,018.00 | $20,396.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $14,573.00 / $17,832.00
| Facility | | $2,530.00 | $14,573.00 | $17,832.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,728.39 / $2,538.00 / $5,602.57
| Facility | | $1,728.39 | $2,538.00 | $5,602.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $481.85 / $895.72 / $895.72
| Facility | AS | $481.85 | $895.72 | $895.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,300.00 / $12,661.00
| Facility | | $1,185.00 | $3,300.00 | $12,661.00 |