- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,898.27 / $2,092.28 / $4,846.00
| Facility | | $1,898.27 | $2,092.28 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.30 / $11,097.00 / $30,091.00
| Facility | | $1,915.30 | $11,097.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.57 / $2,266.64 / $2,615.36
| Facility | | $1,743.57 | $2,266.64 | $2,615.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,230.33
| Facility | | $761.00 | $761.00 | $2,230.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.55 / $218.55 / $218.55
| Facility | AS | $218.55 | $218.55 | $218.55 |
- 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 |