- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.54 / $2,071.08 / $16,042.00
| Facility | | $1,329.54 | $2,071.08 | $16,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,531.00 / $18,682.34 / $27,646.96
| Facility | | $5,531.00 | $18,682.34 | $27,646.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.49 / $1,593.14 / $1,838.24
| Facility | | $1,225.49 | $1,593.14 | $1,838.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.00 / $865.00 / $1,576.70
| Facility | | $865.00 | $865.00 | $1,576.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.72 / $154.72 / $154.72
| Facility | AS | $154.72 | $154.72 | $154.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.00 / $9,550.00 / $15,750.00
| Facility | | $2,529.00 | $9,550.00 | $15,750.00 |