- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,152.00 / $7,119.04 / $20,928.72
| Facility | | $4,152.00 | $7,119.04 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,495.51 / $9,858.65 / $19,069.81
| Facility | | $7,495.51 | $9,858.65 | $19,069.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.93 / $1,413.27 / $7,441.00
| Facility | | $763.93 | $1,413.27 | $7,441.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.44 / $849.00 / $849.00
| Facility | AS | $207.44 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,915.37 / $2,961.89
| Facility | | $1,392.00 | $1,915.37 | $2,961.89 |
- 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 |