- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,302.00 / $13,200.00
| Facility | | $1,300.00 | $4,302.00 | $13,200.00 |
- 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
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.31 / $1,090.10 / $8,986.49
| Facility | | $781.31 | $1,090.10 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $192.66 / $1,887.52 / $1,887.52
| Facility | AS | $192.66 | $1,887.52 | $1,887.52 |
- 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 |