- 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
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,547.00 / $14,547.00 / $14,547.00
| Facility | | $14,547.00 | $14,547.00 | $14,547.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.58 / $1,550.84 / $9,696.00
| Facility | | $861.58 | $1,550.84 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.52 / $5,213.89 / $5,213.89
| Facility | AS | $242.52 | $5,213.89 | $5,213.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,174.78 / $19,137.43
| Facility | | $1,285.00 | $2,174.78 | $19,137.43 |
- 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 |