- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.00 / $4,928.00 / $16,400.00
| Facility | | $1,248.00 | $4,928.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,426.66 / $29,430.37 / $46,509.20
| Facility | | $18,426.66 | $29,430.37 | $46,509.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,980.93 / $23,980.93 / $23,980.93
| Facility | | $23,980.93 | $23,980.93 | $23,980.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.89 / $1,402.92 / $11,495.55
| Facility | | $1,012.89 | $1,402.92 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.06 / $7,997.44 / $7,997.44
| Facility | AS | $246.06 | $7,997.44 | $7,997.44 |
- 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 |