- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,192.00 / $13,200.00
| Facility | | $1,300.00 | $4,192.00 | $13,200.00 |
- 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
- $14,457.89 / $14,457.89 / $14,457.89
| Facility | | $14,457.89 | $14,457.89 | $14,457.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.72 / $1,353.81 / $14,063.00
| Facility | | $968.72 | $1,353.81 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.06 / $4,821.58 / $4,821.58
| Facility | AS | $238.06 | $4,821.58 | $4,821.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $8,072.00 / $14,977.00
| Facility | | $1,851.00 | $8,072.00 | $14,977.00 |