- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,803.00 / $12,600.00
| Facility | | $1,150.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.00 / $9,962.39 / $15,740.47
| Facility | | $6,271.00 | $9,962.39 | $15,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,840.74 / $7,840.74 / $7,840.74
| Facility | | $7,840.74 | $7,840.74 | $7,840.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.62 / $1,229.19 / $8,986.49
| Facility | | $807.62 | $1,229.19 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $198.71 / $2,614.82 / $2,614.82
| Facility | AS | $198.71 | $2,614.82 | $2,614.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |