- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,355.33 / $19,276.96
| Facility | | $4,083.97 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,368.80 / $18,898.90 / $36,556.58
| Facility | | $14,368.80 | $18,898.90 | $36,556.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,514.25 / $13,514.25 / $13,514.25
| Facility | | $13,514.25 | $13,514.25 | $13,514.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.86 / $1,727.75 / $9,696.00
| Facility | | $959.86 | $1,727.75 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.64 / $4,843.72 / $4,843.72
| Facility | AS | $269.64 | $4,843.72 | $4,843.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.58 / $2,401.71 / $17,118.05
| Facility | | $1,227.58 | $2,401.71 | $17,118.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |