- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.31 / $2,223.58 / $4,846.00
| Facility | | $2,015.31 | $2,223.58 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.98 / $2,408.87 / $2,779.47
| Facility | | $1,852.98 | $2,408.87 | $2,779.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,376.52
| Facility | | $761.00 | $761.00 | $2,376.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.27 / $233.27 / $233.27
| Facility | AS | $233.27 | $233.27 | $233.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |