- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,056.00 / $20,274.43
| Facility | | $4,241.22 | $8,056.00 | $20,274.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,619.76 / $8,706.79 / $16,841.75
| Facility | | $6,619.76 | $8,706.79 | $16,841.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.64 / $1,528.82 / $10,876.00
| Facility | | $804.64 | $1,528.82 | $10,876.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.67 / $1,887.52 / $1,887.52
| Facility | AS | $227.67 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.57 / $2,306.75 / $6,616.19
| Facility | | $1,628.57 | $2,306.75 | $6,616.19 |
- 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 |