- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.50 / $2,672.86 / $7,365.00
| Facility | | $858.50 | $2,672.86 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.00 / $5,881.00 / $16,201.00
| Facility | | $2,294.00 | $5,881.00 | $16,201.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,813.00 / $9,841.00 / $14,444.00
| Facility | | $5,813.00 | $9,841.00 | $14,444.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.80 / $1,404.50 / $19,913.50
| Facility | | $846.80 | $1,404.50 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.10 / $234.10 / $1,887.52
| Facility | AS | $234.10 | $234.10 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,738.00 / $6,425.00 / $23,874.12
| Facility | | $2,738.00 | $6,425.00 | $23,874.12 |