- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,355.33 / $19,276.96
| Facility | | $4,083.97 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,687.53 / $6,687.53 / $6,687.53
| Facility | | $6,687.53 | $6,687.53 | $6,687.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.94 / $1,315.90 / $8,816.00
| Facility | | $751.94 | $1,315.90 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.82 / $2,396.92 / $2,396.92
| Facility | AS | $210.82 | $2,396.92 | $2,396.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,878.12 / $8,470.87
| Facility | | $1,089.00 | $1,878.12 | $8,470.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,178.00 / $8,632.00
| Facility | | $4,700.00 | $6,178.00 | $8,632.00 |