- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,078.10 / $10,563.53 / $20,928.72
| Facility | | $4,078.10 | $10,563.53 | $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
- $13,534.86 / $13,534.86 / $13,534.86
| Facility | | $13,534.86 | $13,534.86 | $13,534.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.50 / $1,449.90 / $15,201.00
| Facility | | $805.50 | $1,449.90 | $15,201.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.76 / $4,851.12 / $4,851.12
| Facility | AS | $226.76 | $4,851.12 | $4,851.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,017.95 / $17,282.34
| Facility | | $1,285.00 | $2,017.95 | $17,282.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,696.00 / $19,047.20
| Facility | | $6,777.00 | $9,696.00 | $19,047.20 |