- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.02 / $5,915.00 / $14,100.00
| Facility | | $1,394.02 | $5,915.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,566.31 / $13,539.58 / $21,558.31
| Facility | | $8,566.31 | $13,539.58 | $21,558.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.02 / $2,194.14 / $13,541.98
| Facility | | $1,394.02 | $2,194.14 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,105.03 / $2,105.03 / $2,105.03
| Facility | AS | $2,105.03 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $6,980.00 / $13,541.98
| Facility | | $1,570.00 | $6,980.00 | $13,541.98 |