- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,657.99 / $6,657.99 / $6,657.99
| Facility | | $6,657.99 | $6,657.99 | $6,657.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.65 / $740.34 / $8,632.00
| Facility | | $389.65 | $740.34 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.89 / $2,386.34 / $2,386.34
| Facility | AS | $108.89 | $2,386.34 | $2,386.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.00 / $1,055.75 / $8,433.45
| Facility | | $784.00 | $1,055.75 | $8,433.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |