- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.78 / $3,779.00 / $12,600.00
| Facility | | $1,105.78 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,409.25 / $10,182.03 / $16,087.50
| Facility | | $6,409.25 | $10,182.03 | $16,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.72 / $1,214.09 / $4,596.00
| Facility | | $875.72 | $1,214.09 | $4,596.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $387.54 / $387.54 / $387.54
| Facility | AS | $387.54 | $387.54 | $387.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |