- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,563.53 / $20,928.72
| Facility | | $4,241.22 | $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
- $12,994.88 / $12,994.88 / $12,994.88
| Facility | | $12,994.88 | $12,994.88 | $12,994.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.86 / $1,446.95 / $9,696.00
| Facility | | $803.86 | $1,446.95 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.16 / $4,657.58 / $4,657.58
| Facility | AS | $226.16 | $4,657.58 | $4,657.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,012.85 / $16,488.95
| Facility | | $1,285.00 | $2,012.85 | $16,488.95 |
- 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 |