- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.50 / $3,683.00 / $8,400.00
| Facility | | $804.50 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,387.39 / $10,015.81 / $15,625.45
| Facility | | $6,387.39 | $10,015.81 | $15,625.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,383.66 / $7,383.66 / $7,383.66
| Facility | | $7,383.66 | $7,383.66 | $7,383.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.43 / $960.14 / $6,889.15
| Facility | | $671.43 | $960.14 | $6,889.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.43 / $2,462.39 / $2,462.39
| Facility | AS | $165.43 | $2,462.39 | $2,462.39 |
- 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 |