- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $6,126.00 / $15,090.00
| Facility | | $2,114.00 | $6,126.00 | $15,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,267.11 / $13,287.53 / $20,117.72
| Facility | | $3,267.11 | $13,287.53 | $20,117.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.79 / $1,046.16 / $18,669.00
| Facility | | $798.79 | $1,046.16 | $18,669.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.89 / $207.89 / $9,733.53
| Facility | AS | $207.89 | $207.89 | $9,733.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,702.00 / $14,586.00 / $20,457.00
| Facility | | $3,702.00 | $14,586.00 | $20,457.00 |