- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $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
- $13,171.73 / $13,171.73 / $13,171.73
| Facility | | $13,171.73 | $13,171.73 | $13,171.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.90 / $1,370.08 / $9,696.00
| Facility | | $782.90 | $1,370.08 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.82 / $4,720.97 / $4,720.97
| Facility | AS | $219.82 | $4,720.97 | $4,720.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,980.59 / $16,772.16
| Facility | | $1,285.00 | $1,980.59 | $16,772.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,496.00 / $11,600.83
| Facility | | $6,777.00 | $9,496.00 | $11,600.83 |