- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- 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
- $7,094.64 / $7,094.64 / $7,094.64
| Facility | | $7,094.64 | $7,094.64 | $7,094.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.85 / $1,599.93 / $9,696.00
| Facility | | $888.85 | $1,599.93 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.23 / $2,542.84 / $2,542.84
| Facility | AS | $249.23 | $2,542.84 | $2,542.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.19 / $2,222.71 / $8,753.16
| Facility | | $1,137.19 | $2,222.71 | $8,753.16 |
- 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 |