- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,856.00 / $14,100.00
| Facility | | $1,392.00 | $4,856.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,954.18 / $11,047.74 / $17,455.31
| Facility | | $6,954.18 | $11,047.74 | $17,455.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,226.70 / $3,226.70 / $3,226.70
| Facility | | $3,226.70 | $3,226.70 | $3,226.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.55 / $1,231.55 / $8,753.15
| Facility | | $886.55 | $1,231.55 | $8,753.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.14 / $1,076.08 / $1,076.08
| Facility | AS | $218.14 | $1,076.08 | $1,076.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |