- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.00 / $9,185.68 / $20,928.72
| Facility | | $1,836.00 | $9,185.68 | $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
- $924.92 / $1,618.61 / $9,496.00
| Facility | | $924.92 | $1,618.61 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.80 / $1,887.52 / $1,887.52
| Facility | AS | $258.80 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,809.25 / $2,492.63 / $6,616.19
| Facility | | $1,809.25 | $2,492.63 | $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 |