- 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
- $13,452.45 / $13,452.45 / $13,452.45
| Facility | | $13,452.45 | $13,452.45 | $13,452.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.86 / $1,478.51 / $9,696.00
| Facility | | $844.86 | $1,478.51 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.06 / $4,821.58 / $4,821.58
| Facility | AS | $238.06 | $4,821.58 | $4,821.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,118.37 / $17,316.27
| Facility | | $1,285.00 | $2,118.37 | $17,316.27 |
- 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 |