- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $13,200.00
| Facility | | $1,346.00 | $4,195.00 | $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
- $14,479.10 / $14,479.10 / $14,479.10
| Facility | | $14,479.10 | $14,479.10 | $14,479.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.25 / $1,574.43 / $14,063.00
| Facility | | $1,141.25 | $1,574.43 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.58 / $4,828.66 / $4,828.66
| Facility | AS | $276.58 | $4,828.66 | $4,828.66 |
- 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 |