- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- 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
- $21,136.59 / $21,136.59 / $21,136.59
| Facility | | $21,136.59 | $21,136.59 | $21,136.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.59 / $1,649.53 / $9,696.00
| Facility | | $942.59 | $1,649.53 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $262.95 / $7,575.71 / $7,575.71
| Facility | AS | $262.95 | $7,575.71 | $7,575.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.70 / $2,561.71 / $27,268.38
| Facility | | $1,681.70 | $2,561.71 | $27,268.38 |
- 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 |