- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $8,477.27 / $21,899.37
| Facility | | $4,241.22 | $8,477.27 | $21,899.37 |
- 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
- $12,713.30 / $12,713.30 / $12,713.30
| Facility | | $12,713.30 | $12,713.30 | $12,713.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.91 / $1,340.34 / $9,696.00
| Facility | | $765.91 | $1,340.34 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.63 / $4,556.66 / $4,556.66
| Facility | AS | $215.63 | $4,556.66 | $4,556.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,919.00 / $16,497.45
| Facility | | $1,392.00 | $1,919.00 | $16,497.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |