- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.82 / $3,803.00 / $12,600.00
| Facility | | $1,062.82 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,019.62 / $12,575.25 / $19,618.43
| Facility | | $8,019.62 | $12,575.25 | $19,618.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,363.15 / $7,363.15 / $7,363.15
| Facility | | $7,363.15 | $7,363.15 | $7,363.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.01 / $1,148.30 / $14,063.00
| Facility | | $803.01 | $1,148.30 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.41 / $2,455.55 / $2,455.55
| Facility | AS | $196.41 | $2,455.55 | $2,455.55 |
- 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 |