- 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
- $7,197.33 / $7,197.33 / $7,197.33
| Facility | | $7,197.33 | $7,197.33 | $7,197.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.41 / $1,176.72 / $9,496.00
| Facility | | $672.41 | $1,176.72 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.25 / $2,579.65 / $2,579.65
| Facility | AS | $189.25 | $2,579.65 | $2,579.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,776.41 / $9,116.62
| Facility | | $1,285.00 | $1,776.41 | $9,116.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |