- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,350.00 / $13,200.00
| Facility | | $1,346.00 | $4,350.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,304.37 / $13,120.82
| Facility | | $5,227.34 | $8,304.37 | $13,120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,544.32 / $7,544.32 / $7,544.32
| Facility | | $7,544.32 | $7,544.32 | $7,544.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.88 / $914.20 / $8,986.49
| Facility | | $680.88 | $914.20 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.58 / $2,515.96 / $2,515.96
| Facility | AS | $168.58 | $2,515.96 | $2,515.96 |
- 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 |