- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,946.52 / $6,946.52 / $6,946.52
| Facility | | $6,946.52 | $6,946.52 | $6,946.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.03 / $1,071.05 / $9,496.00
| Facility | | $595.03 | $1,071.05 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $167.29 / $2,489.75 / $2,489.75
| Facility | AS | $167.29 | $2,489.75 | $2,489.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.77 / $1,553.00 / $8,798.92
| Facility | | $1,202.77 | $1,553.00 | $8,798.92 |
- 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 |