- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,015.13 / $8,355.33 / $19,276.96
| Facility | | $3,015.13 | $8,355.33 | $19,276.96 |
- 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
- $13,138.25 / $13,138.25 / $13,138.25
| Facility | | $13,138.25 | $13,138.25 | $13,138.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.45 / $1,946.46 / $9,496.00
| Facility | | $1,024.45 | $1,946.46 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $286.66 / $4,708.97 / $4,708.97
| Facility | AS | $286.66 | $4,708.97 | $4,708.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.13 / $2,558.92 / $17,062.77
| Facility | | $1,276.13 | $2,558.92 | $17,062.77 |
- 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 |