- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.00 / $8,042.03 / $19,276.96
| Facility | | $3,230.00 | $8,042.03 | $19,276.96 |
- 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
- $6,783.41 / $6,783.41 / $6,783.41
| Facility | | $6,783.41 | $6,783.41 | $6,783.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.40 / $1,667.59 / $9,496.00
| Facility | | $901.40 | $1,667.59 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.87 / $2,431.29 / $2,431.29
| Facility | AS | $251.87 | $2,431.29 | $2,431.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.13 / $2,324.17 / $8,592.31
| Facility | | $1,130.13 | $2,324.17 | $8,592.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |