- 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
- $26,463.60 / $34,806.86 / $67,327.71
| Facility | | $26,463.60 | $34,806.86 | $67,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,764.84 / $22,764.84 / $22,764.84
| Facility | | $22,764.84 | $22,764.84 | $22,764.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.81 / $1,260.99 / $15,622.00
| Facility | | $734.81 | $1,260.99 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $203.97 / $8,159.30 / $8,159.30
| Facility | AS | $203.97 | $8,159.30 | $8,159.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.08 / $1,957.20 / $28,671.51
| Facility | | $1,076.08 | $1,957.20 | $28,671.51 |
- 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 |