- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $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
- $7,377.81 / $7,377.81 / $7,377.81
| Facility | | $7,377.81 | $7,377.81 | $7,377.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.88 / $1,084.63 / $14,063.00
| Facility | | $749.88 | $1,084.63 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.90 / $2,460.44 / $2,460.44
| Facility | AS | $183.90 | $2,460.44 | $2,460.44 |
- 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 |