- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.05 / $8,477.27 / $21,899.37
| Facility | | $1,940.05 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,980.41 / $13,980.41 / $13,980.41
| Facility | | $13,980.41 | $13,980.41 | $13,980.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.06 / $1,650.36 / $9,696.00
| Facility | | $943.06 | $1,650.36 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.38 / $5,010.81 / $5,010.81
| Facility | AS | $265.38 | $5,010.81 | $5,010.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $2,520.86 / $17,708.50
| Facility | | $1,392.00 | $2,520.86 | $17,708.50 |
- 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 |