- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.85 / $1,888.60 / $4,846.00
| Facility | | $1,711.85 | $1,888.60 | $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
- $1,605.31 / $2,045.98 / $2,360.75
| Facility | | $1,605.31 | $2,045.98 | $2,360.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $2,000.53
| Facility | | $761.00 | $761.00 | $2,000.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.33 / $196.33 / $196.33
| Facility | AS | $196.33 | $196.33 | $196.33 |
- 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 |