- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.73 / $4,192.00 / $13,200.00
| Facility | | $1,292.73 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,214.31 / $14,214.31 / $14,214.31
| Facility | | $14,214.31 | $14,214.31 | $14,214.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.33 / $1,448.63 / $14,063.00
| Facility | | $1,047.33 | $1,448.63 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $4,740.35 / $4,740.35
| Facility | AS | $254.28 | $4,740.35 | $4,740.35 |
- 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 |