- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.88 / $1,418.82 / $4,846.00
| Facility | | $1,283.88 | $1,418.82 | $4,846.00 |
- 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
- $1,182.34 / $1,537.06 / $1,773.53
| Facility | | $1,182.34 | $1,537.06 | $1,773.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,512.50
| Facility | | $761.00 | $761.00 | $1,512.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.22 / $148.22 / $148.22
| Facility | AS | $148.22 | $148.22 | $148.22 |
- 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 |