- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.00 / $4,348.00 / $12,600.00
| Facility | | $1,163.00 | $4,348.00 | $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
- $13,681.03 / $13,681.03 / $13,681.03
| Facility | | $13,681.03 | $13,681.03 | $13,681.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.35 / $1,246.17 / $14,063.00
| Facility | | $874.35 | $1,246.17 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.38 / $4,562.51 / $4,562.51
| Facility | AS | $215.38 | $4,562.51 | $4,562.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.00 / $9,200.00 / $15,388.63
| Facility | | $2,209.00 | $9,200.00 | $15,388.63 |