- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,551.00 / $16,900.00
| Facility | | $1,456.00 | $5,551.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,954.18 / $11,047.74 / $17,455.31
| Facility | | $6,954.18 | $11,047.74 | $17,455.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,821.20 / $7,821.20 / $7,821.20
| Facility | | $7,821.20 | $7,821.20 | $7,821.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.67 / $1,009.66 / $8,986.49
| Facility | | $661.67 | $1,009.66 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.08 / $2,608.31 / $2,608.31
| Facility | AS | $165.08 | $2,608.31 | $2,608.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,910.00 / $9,232.95
| Facility | | $1,481.00 | $5,910.00 | $9,232.95 |