- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,952.65 / $9,144.62 / $17,688.66
| Facility | | $6,952.65 | $9,144.62 | $17,688.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,674.81 / $6,674.81 / $6,674.81
| Facility | | $6,674.81 | $6,674.81 | $6,674.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.37 / $1,307.90 / $8,816.00
| Facility | | $747.37 | $1,307.90 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.68 / $2,392.36 / $2,392.36
| Facility | AS | $209.68 | $2,392.36 | $2,392.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,870.90 / $8,332.41
| Facility | | $1,392.00 | $1,870.90 | $8,332.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |