- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.69 / $4,195.00 / $13,200.00
| Facility | | $1,324.69 | $4,195.00 | $13,200.00 |
- 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
- $15,634.24 / $15,634.24 / $15,634.24
| Facility | | $15,634.24 | $15,634.24 | $15,634.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.75 / $1,416.96 / $14,063.00
| Facility | | $985.75 | $1,416.96 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.52 / $5,213.89 / $5,213.89
| Facility | AS | $242.52 | $5,213.89 | $5,213.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,587.03
| Facility | | $1,851.00 | $7,074.00 | $14,587.03 |