- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.28 / $3,683.00 / $12,600.00
| Facility | | $1,012.28 | $3,683.00 | $12,600.00 |
- 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
- $7,429.07 / $7,429.07 / $7,429.07
| Facility | | $7,429.07 | $7,429.07 | $7,429.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.26 / $1,289.75 / $14,063.00
| Facility | | $920.26 | $1,289.75 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.97 / $2,477.53 / $2,477.53
| Facility | AS | $223.97 | $2,477.53 | $2,477.53 |
- 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 |