- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.41 / $9,185.68 / $20,928.72
| Facility | | $923.41 | $9,185.68 | $20,928.72 |
- 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
- $14,383.89 / $14,383.89 / $14,383.89
| Facility | | $14,383.89 | $14,383.89 | $14,383.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.41 / $1,662.14 / $9,696.00
| Facility | | $923.41 | $1,662.14 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.20 / $5,155.43 / $5,155.43
| Facility | AS | $258.20 | $5,155.43 | $5,155.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,338.33 / $18,219.59
| Facility | | $1,285.00 | $2,338.33 | $18,219.59 |
- 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 |