- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.61 / $3,803.00 / $12,600.00
| Facility | | $1,129.61 | $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
- $7,607.81 / $7,607.81 / $7,607.81
| Facility | | $7,607.81 | $7,607.81 | $7,607.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.11 / $1,280.00 / $8,986.49
| Facility | | $843.11 | $1,280.00 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.69 / $2,537.14 / $2,537.14
| Facility | AS | $206.69 | $2,537.14 | $2,537.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,436.21 / $9,232.95
| Facility | | $1,481.00 | $5,436.21 | $9,232.95 |