- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,633.46 / $8,477.27 / $19,276.96
| Facility | | $3,633.46 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,018.72 / $10,546.81 / $20,400.93
| Facility | | $8,018.72 | $10,546.81 | $20,400.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,078.74 / $7,078.74 / $7,078.74
| Facility | | $7,078.74 | $7,078.74 | $7,078.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.06 / $1,353.53 / $8,892.70
| Facility | | $735.06 | $1,353.53 | $8,892.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.69 / $2,537.14 / $2,537.14
| Facility | AS | $206.69 | $2,537.14 | $2,537.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,976.18 / $8,966.40
| Facility | | $1,089.00 | $1,976.18 | $8,966.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,569.59 / $7,221.00 / $8,816.00
| Facility | | $5,569.59 | $7,221.00 | $8,816.00 |