- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.56 / $4,192.00 / $13,200.00
| Facility | | $1,223.56 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,575.25 / $19,872.87
| Facility | | $7,873.50 | $12,575.25 | $19,872.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,966.11 / $13,966.11 / $13,966.11
| Facility | | $13,966.11 | $13,966.11 | $13,966.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.67 / $1,322.28 / $14,063.00
| Facility | | $924.67 | $1,322.28 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.16 / $4,657.58 / $4,657.58
| Facility | AS | $226.16 | $4,657.58 | $4,657.58 |
- 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 |