- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,915.56 / $25,184.28
| Facility | | $4,241.22 | $10,915.56 | $25,184.28 |
- 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
- $14,397.63 / $14,397.63 / $14,397.63
| Facility | | $14,397.63 | $14,397.63 | $14,397.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.15 / $1,092.26 / $15,622.00
| Facility | | $624.15 | $1,092.26 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.13 / $5,160.35 / $5,160.35
| Facility | AS | $176.13 | $5,160.35 | $5,160.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.94 / $1,679.92 / $18,680.30
| Facility | | $1,257.94 | $1,679.92 | $18,680.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |