- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.47 / $3,742.00 / $12,600.00
| Facility | | $1,077.47 | $3,742.00 | $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
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.47 / $1,544.31 / $14,063.00
| Facility | | $1,077.47 | $1,544.31 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $268.62 / $1,887.52 / $1,887.52
| Facility | AS | $268.62 | $1,887.52 | $1,887.52 |
- 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 |