- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.36 / $1,484.62 / $4,846.00
| Facility | | $1,345.36 | $1,484.62 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $12,048.87 / $16,615.00
| Facility | | $4,600.00 | $12,048.87 | $16,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.18 / $1,608.33 / $1,855.77
| Facility | | $1,237.18 | $1,608.33 | $1,855.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,601.71
| Facility | | $761.00 | $761.00 | $1,601.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.62 / $156.62 / $156.62
| Facility | AS | $156.62 | $156.62 | $156.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,995.00 / $9,243.00
| Facility | | $1,500.00 | $5,995.00 | $9,243.00 |