- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- 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
- $13,472.19 / $13,472.19 / $13,472.19
| Facility | | $13,472.19 | $13,472.19 | $13,472.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.70 / $1,728.48 / $9,696.00
| Facility | | $987.70 | $1,728.48 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.58 / $4,828.66 / $4,828.66
| Facility | AS | $276.58 | $4,828.66 | $4,828.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,525.84 / $16,954.59
| Facility | | $1,285.00 | $2,525.84 | $16,954.59 |
- 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 |