- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,563.53 / $20,928.72
| Facility | | $4,241.22 | $10,563.53 | $20,928.72 |
- 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
- $13,351.14 / $13,351.14 / $13,351.14
| Facility | | $13,351.14 | $13,351.14 | $13,351.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.35 / $1,428.61 / $9,696.00
| Facility | | $816.35 | $1,428.61 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $229.60 / $4,785.27 / $4,785.27
| Facility | AS | $229.60 | $4,785.27 | $4,785.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,044.19 / $17,197.48
| Facility | | $1,285.00 | $2,044.19 | $17,197.48 |
- 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 |