- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,915.00 / $14,100.00
| Facility | | $1,456.00 | $5,915.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,488.15 / $7,488.15 / $7,488.15
| Facility | | $7,488.15 | $7,488.15 | $7,488.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.34 / $1,268.34 / $11,495.55
| Facility | | $918.34 | $1,268.34 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.93 / $2,497.23 / $2,497.23
| Facility | AS | $223.93 | $2,497.23 | $2,497.23 |
- 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 |