- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.50 / $8,477.27 / $20,928.72
| Facility | | $4,570.50 | $8,477.27 | $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
- $7,146.44 / $7,146.44 / $7,146.44
| Facility | | $7,146.44 | $7,146.44 | $7,146.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.70 / $1,403.60 / $9,496.00
| Facility | | $758.70 | $1,403.60 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.46 / $2,561.40 / $2,561.40
| Facility | AS | $214.46 | $2,561.40 | $2,561.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,904.38 / $9,052.15
| Facility | | $1,392.00 | $1,904.38 | $9,052.15 |
- 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 |