- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.68 / $3,742.00 / $12,600.00
| Facility | | $943.68 | $3,742.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,202.49 / $7,202.49 / $7,202.49
| Facility | | $7,202.49 | $7,202.49 | $7,202.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.44 / $1,004.73 / $14,063.00
| Facility | | $702.44 | $1,004.73 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.07 / $2,401.96 / $2,401.96
| Facility | AS | $174.07 | $2,401.96 | $2,401.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $14,139.00
| Facility | | $1,851.00 | $6,980.00 | $14,139.00 |