- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- 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
- $6,865.64 / $6,865.64 / $6,865.64
| Facility | | $6,865.64 | $6,865.64 | $6,865.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.31 / $1,691.00 / $9,496.00
| Facility | | $945.31 | $1,691.00 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.95 / $2,460.76 / $2,460.76
| Facility | AS | $265.95 | $2,460.76 | $2,460.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,543.85 / $8,731.03
| Facility | | $1,285.00 | $2,543.85 | $8,731.03 |
- 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 |