- 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
- $7,921.80 / $10,419.34 / $20,154.36
| Facility | | $7,921.80 | $10,419.34 | $20,154.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,256.83 / $14,256.83 / $14,256.83
| Facility | | $14,256.83 | $14,256.83 | $14,256.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.12 / $1,107.96 / $9,696.00
| Facility | | $633.12 | $1,107.96 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.31 / $5,109.89 / $5,109.89
| Facility | AS | $177.31 | $5,109.89 | $5,109.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.45 / $1,593.44 / $17,202.18
| Facility | | $1,275.45 | $1,593.44 | $17,202.18 |
- 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 |