- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,417.02 / $12,036.14 / $27,034.77
| Facility | | $5,417.02 | $12,036.14 | $27,034.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,495.51 / $9,858.65 / $19,069.81
| Facility | | $7,495.51 | $9,858.65 | $19,069.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,277.30 / $7,277.30 / $7,277.30
| Facility | | $7,277.30 | $7,277.30 | $7,277.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.79 / $1,078.16 / $8,816.00
| Facility | | $582.79 | $1,078.16 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.08 / $2,608.31 / $2,608.31
| Facility | AS | $165.08 | $2,608.31 | $2,608.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.00 / $1,717.42 / $9,217.91
| Facility | | $1,137.00 | $1,717.42 | $9,217.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |