- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $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
- $21,293.73 / $21,293.73 / $21,293.73
| Facility | | $21,293.73 | $21,293.73 | $21,293.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.86 / $2,071.76 / $9,696.00
| Facility | | $1,119.86 | $2,071.76 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $313.63 / $7,632.03 / $7,632.03
| Facility | AS | $313.63 | $7,632.03 | $7,632.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.60 / $3,018.54 / $25,628.73
| Facility | | $1,441.60 | $3,018.54 | $25,628.73 |
- 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 |