- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $4,192.00 / $13,200.00
| Facility | | $1,150.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,546.46 / $14,546.46 / $14,546.46
| Facility | | $14,546.46 | $14,546.46 | $14,546.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.11 / $1,287.58 / $14,063.00
| Facility | | $920.11 | $1,287.58 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.76 / $4,851.12 / $4,851.12
| Facility | AS | $226.76 | $4,851.12 | $4,851.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,977.00
| Facility | | $1,851.00 | $7,307.00 | $14,977.00 |