- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.00 / $8,477.27 / $19,276.96
| Facility | | $3,230.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,018.72 / $10,546.81 / $20,400.93
| Facility | | $8,018.72 | $10,546.81 | $20,400.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,295.48 / $7,295.48 / $7,295.48
| Facility | | $7,295.48 | $7,295.48 | $7,295.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.59 / $1,269.90 / $8,816.00
| Facility | | $705.59 | $1,269.90 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $198.71 / $2,614.82 / $2,614.82
| Facility | AS | $198.71 | $2,614.82 | $2,614.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,897.38 / $8,925.17
| Facility | | $1,089.00 | $1,897.38 | $8,925.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |