- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.45 / $10,431.19 / $24,068.03
| Facility | | $4,774.45 | $10,431.19 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,007.92 / $21,007.92 / $21,007.92
| Facility | | $21,007.92 | $21,007.92 | $21,007.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.62 / $2,605.48 / $15,201.00
| Facility | | $1,419.62 | $2,605.48 | $15,201.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.38 / $7,529.59 / $7,529.59
| Facility | AS | $398.38 | $7,529.59 | $7,529.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $3,869.82 / $26,170.11
| Facility | | $2,862.00 | $3,869.82 | $26,170.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,939.00 / $8,158.00 / $9,496.00
| Facility | | $6,939.00 | $8,158.00 | $9,496.00 |