- 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
- $9,132.98 / $14,509.07 / $22,924.17
| Facility | | $9,132.98 | $14,509.07 | $22,924.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,173.68 / $7,173.68 / $7,173.68
| Facility | | $7,173.68 | $7,173.68 | $7,173.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.48 / $1,169.77 / $7,405.00
| Facility | | $860.48 | $1,169.77 | $7,405.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.68 / $2,392.36 / $2,392.36
| Facility | AS | $209.68 | $2,392.36 | $2,392.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |