- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,856.00 / $14,100.00
| Facility | | $1,392.00 | $4,856.00 | $14,100.00 |
- 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
- $7,202.97 / $7,202.97 / $7,202.97
| Facility | | $7,202.97 | $7,202.97 | $7,202.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.68 / $1,100.00 / $14,063.00
| Facility | | $831.68 | $1,100.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.74 / $2,402.13 / $2,402.13
| Facility | AS | $205.74 | $2,402.13 | $2,402.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |