- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.42 / $8,477.27 / $20,928.72
| Facility | | $2,128.42 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.00 / $1,629.00 / $9,455.00
| Facility | | $905.00 | $1,629.00 | $9,455.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.07 / $1,887.52 / $1,887.52
| Facility | AS | $254.07 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.37 / $2,433.63 / $6,616.19
| Facility | | $1,775.37 | $2,433.63 | $6,616.19 |
- 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 |