- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,368.80 / $18,898.90 / $36,556.58
| Facility | | $14,368.80 | $18,898.90 | $36,556.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,502.24 / $13,502.24 / $13,502.24
| Facility | | $13,502.24 | $13,502.24 | $13,502.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.77 / $1,768.99 / $16,016.97
| Facility | | $982.77 | $1,768.99 | $16,016.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.79 / $4,839.43 / $4,839.43
| Facility | AS | $276.79 | $4,839.43 | $4,839.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,464.73 / $17,102.83
| Facility | | $1,285.00 | $2,464.73 | $17,102.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $9,496.00 / $11,600.83
| Facility | | $6,777.00 | $9,496.00 | $11,600.83 |