- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.08 / $6,809.60 / $13,151.00
| Facility | | $1,272.08 | $6,809.60 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $6,337.00 / $15,385.00
| Facility | | $2,530.00 | $6,337.00 | $15,385.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,965.00 / $11,477.00 / $18,676.00
| Facility | | $9,965.00 | $11,477.00 | $18,676.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.04 / $1,461.55 / $12,989.00
| Facility | | $727.04 | $1,461.55 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.48 / $2,632.21 / $2,632.21
| Facility | AS | $210.48 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,858.00 / $6,038.00 / $12,989.00
| Facility | | $2,858.00 | $6,038.00 | $12,989.00 |