- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,100.08 / $23,483.17
| Facility | | $4,241.22 | $11,100.08 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,464.47 / $13,464.47 / $13,464.47
| Facility | | $13,464.47 | $13,464.47 | $13,464.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.26 / $2,041.03 / $13,127.84
| Facility | | $1,103.26 | $2,041.03 | $13,127.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $310.70 / $4,825.89 / $4,825.89
| Facility | AS | $310.70 | $4,825.89 | $4,825.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,227.83 / $3,012.16 / $17,054.99
| Facility | | $2,227.83 | $3,012.16 | $17,054.99 |
- 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 |