- 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
- $7,003.91 / $9,212.06 / $17,819.09
| Facility | | $7,003.91 | $9,212.06 | $17,819.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,808.85 / $6,808.85 / $6,808.85
| Facility | | $6,808.85 | $6,808.85 | $6,808.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.48 / $1,033.33 / $8,816.00
| Facility | | $590.48 | $1,033.33 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $166.76 / $2,440.41 / $2,440.41
| Facility | AS | $166.76 | $2,440.41 | $2,440.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.00 / $1,553.00 / $8,624.54
| Facility | | $1,192.00 | $1,553.00 | $8,624.54 |
- 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 |