- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,995.87 / $30,107.00
| Facility | | $4,241.22 | $11,995.87 | $30,107.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,999.34 / $17,097.68 / $33,072.44
| Facility | | $12,999.34 | $17,097.68 | $33,072.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,444.68 / $21,444.68 / $21,444.68
| Facility | | $21,444.68 | $21,444.68 | $21,444.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.08 / $2,296.14 / $15,622.00
| Facility | | $1,312.08 | $2,296.14 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $367.74 / $7,686.13 / $7,686.13
| Facility | AS | $367.74 | $7,686.13 | $7,686.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $3,301.99 / $26,624.83
| Facility | | $1,932.00 | $3,301.99 | $26,624.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $15,622.00 / $27,223.43
| Facility | | $8,148.00 | $15,622.00 | $27,223.43 |