- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $924.47 / $9,185.68 / $20,928.72
| Facility | | $924.47 | $9,185.68 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,170.98 / $14,170.98 / $14,170.98
| Facility | | $14,170.98 | $14,170.98 | $14,170.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.89 / $1,286.80 / $13,192.00
| Facility | | $714.89 | $1,286.80 | $13,192.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.22 / $5,079.12 / $5,079.12
| Facility | AS | $201.22 | $5,079.12 | $5,079.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,888.45 / $17,949.91
| Facility | | $1,285.00 | $1,888.45 | $17,949.91 |
- 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 |