- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.05 / $4,195.00 / $13,200.00
| Facility | | $1,398.05 | $4,195.00 | $13,200.00 |
- 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
- $14,487.40 / $14,487.40 / $14,487.40
| Facility | | $14,487.40 | $14,487.40 | $14,487.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.05 / $1,881.48 / $14,063.00
| Facility | | $1,398.05 | $1,881.48 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $337.62 / $4,831.43 / $4,831.43
| Facility | AS | $337.62 | $4,831.43 | $4,831.43 |
- 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 |