- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,301.06 / $7,119.04 / $19,276.96
| Facility | | $3,301.06 | $7,119.04 | $19,276.96 |
- 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
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.48 / $1,116.44 / $8,816.00
| Facility | | $608.48 | $1,116.44 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.49 / $1,887.52 / $1,887.52
| Facility | AS | $171.49 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,632.47 / $6,616.19
| Facility | | $1,089.00 | $1,632.47 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |