- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,909.00 / $12,600.00
| Facility | | $1,200.00 | $3,909.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,132.98 / $14,509.07 / $22,924.17
| Facility | | $9,132.98 | $14,509.07 | $22,924.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.44 / $1,414.28 / $8,986.49
| Facility | | $1,028.44 | $1,414.28 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.26 / $1,887.52 / $1,887.52
| Facility | AS | $257.26 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $6,627.00 / $10,811.00
| Facility | | $1,862.00 | $6,627.00 | $10,811.00 |