- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,741.14 / $1,974.21 / $8,229.00
| Facility | | $1,741.14 | $1,974.21 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,565.00 / $6,410.00 / $14,034.00
| Facility | | $3,565.00 | $6,410.00 | $14,034.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.34 / $2,333.80 / $2,692.21
| Facility | | $1,700.34 | $2,333.80 | $2,692.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.10 / $2,052.10 / $2,052.10
| Facility | | $2,052.10 | $2,052.10 | $2,052.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $200.73 / $200.73 / $200.73
| Facility | AS | $200.73 | $200.73 | $200.73 |
- 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 |