- 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
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,967.41 / $6,967.41 / $6,967.41
| Facility | | $6,967.41 | $6,967.41 | $6,967.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.47 / $1,397.11 / $9,496.00
| Facility | | $796.47 | $1,397.11 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.93 / $2,497.23 / $2,497.23
| Facility | AS | $223.93 | $2,497.23 | $2,497.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.16 / $2,143.69 / $8,878.27
| Facility | | $1,604.16 | $2,143.69 | $8,878.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |