- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,779.00 / $12,600.00
| Facility | | $1,150.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,624.89 / $7,624.89 / $7,624.89
| Facility | | $7,624.89 | $7,624.89 | $7,624.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.40 / $1,404.94 / $14,063.00
| Facility | | $973.40 | $1,404.94 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.23 / $2,542.84 / $2,542.84
| Facility | AS | $249.23 | $2,542.84 | $2,542.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |