- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,195.00 / $13,200.00
| Facility | | $1,300.00 | $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
- $16,023.58 / $16,023.58 / $16,023.58
| Facility | | $16,023.58 | $16,023.58 | $16,023.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.62 / $1,179.21 / $14,063.00
| Facility | | $824.62 | $1,179.21 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.75 / $5,343.73 / $5,343.73
| Facility | AS | $201.75 | $5,343.73 | $5,343.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $14,139.00
| Facility | | $1,851.00 | $6,980.00 | $14,139.00 |