- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,774.45 / $11,265.38 / $23,483.17
| Facility | | $4,774.45 | $11,265.38 | $23,483.17 |
- 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
- $22,313.24 / $22,313.24 / $22,313.24
| Facility | | $22,313.24 | $22,313.24 | $22,313.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.69 / $1,557.71 / $9,496.00
| Facility | | $877.69 | $1,557.71 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.06 / $7,997.44 / $7,997.44
| Facility | AS | $246.06 | $7,997.44 | $7,997.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.83 / $2,362.65 / $28,263.43
| Facility | | $1,767.83 | $2,362.65 | $28,263.43 |
- 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 |