- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,975.92 / $2,123.67 / $8,229.00
| Facility | | $1,975.92 | $2,123.67 | $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
- $1,969.24 / $2,702.87 / $3,117.96
| Facility | | $1,969.24 | $2,702.87 | $3,117.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.52 / $2,376.52 / $2,376.52
| Facility | | $2,376.52 | $2,376.52 | $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
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |