- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,990.74 / $13,540.02 / $25,418.08
| Facility | | $9,990.74 | $13,540.02 | $25,418.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.43 / $1,453.52 / $7,856.00
| Facility | | $884.43 | $1,453.52 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $411.15 / $411.15 / $411.15
| Facility | AS | $411.15 | $411.15 | $411.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,542.00 / $2,022.91 / $2,808.36
| Facility | | $1,542.00 | $2,022.91 | $2,808.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |