- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,892.02 / $2,132.40 / $8,229.00
| Facility | | $1,892.02 | $2,132.40 | $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
- $1,845.18 / $2,532.60 / $2,921.54
| Facility | | $1,845.18 | $2,532.60 | $2,921.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.33 / $2,230.33 / $2,230.33
| Facility | | $2,230.33 | $2,230.33 | $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
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |