- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.42 / $3,683.00 / $12,600.00
| Facility | | $1,176.42 | $3,683.00 | $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
- $14,120.20 / $14,120.20 / $14,120.20
| Facility | | $14,120.20 | $14,120.20 | $14,120.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.42 / $1,570.21 / $14,063.00
| Facility | | $1,176.42 | $1,570.21 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $286.66 / $4,708.97 / $4,708.97
| Facility | AS | $286.66 | $4,708.97 | $4,708.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,139.00
| Facility | | $1,851.00 | $7,307.00 | $14,139.00 |