- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,302.30 / $5,141.75 / $16,467.00
| Facility | | $2,302.30 | $5,141.75 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.32 / $10,619.00 / $14,963.00
| Facility | | $2,269.32 | $10,619.00 | $14,963.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $225.03 / $225.03 / $225.03
| Facility | AS | $225.03 | $225.03 | $225.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,121.71 / $2,534.00 / $4,400.05
| Facility | | $2,121.71 | $2,534.00 | $4,400.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $311.83 / $354.76 / $572.64
| Facility | AS | $311.83 | $354.76 | $572.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |