- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,541.21 / $8,477.27 / $21,899.37
| Facility | | $2,541.21 | $8,477.27 | $21,899.37 |
- 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
- $6,827.01 / $6,827.01 / $6,827.01
| Facility | | $6,827.01 | $6,827.01 | $6,827.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.98 / $1,249.47 / $9,496.00
| Facility | | $713.98 | $1,249.47 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.43 / $2,446.92 / $2,446.92
| Facility | AS | $201.43 | $2,446.92 | $2,446.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.01 / $1,790.98 / $8,283.12
| Facility | | $1,166.01 | $1,790.98 | $8,283.12 |
- 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 |