- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.57 / $5,726.12 / $14,100.00
| Facility | | $1,161.57 | $5,726.12 | $14,100.00 |
- 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
- $7,680.56 / $7,680.56 / $7,680.56
| Facility | | $7,680.56 | $7,680.56 | $7,680.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.98 / $1,239.78 / $14,063.00
| Facility | | $866.98 | $1,239.78 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.46 / $2,561.40 / $2,561.40
| Facility | AS | $214.46 | $2,561.40 | $2,561.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,139.00
| Facility | | $1,851.00 | $7,307.00 | $14,139.00 |