- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,756.00 / $13,959.06
| Facility | | $1,392.00 | $4,756.00 | $13,959.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,328.66 / $19,332.08 / $30,159.63
| Facility | | $12,328.66 | $19,332.08 | $30,159.63 |
- 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
- $1,071.92 / $1,525.91 / $11,615.00
| Facility | | $1,071.92 | $1,525.91 | $11,615.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $259.20 / $1,887.52 / $1,887.52
| Facility | AS | $259.20 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.00 / $8,835.00 / $14,587.03
| Facility | | $1,940.00 | $8,835.00 | $14,587.03 |