- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.34 / $7,120.36 / $19,148.84
| Facility | | $1,175.34 | $7,120.36 | $19,148.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,783.07 / $14,783.07 / $14,783.07
| Facility | | $14,783.07 | $14,783.07 | $14,783.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.63 / $1,226.85 / $16,016.97
| Facility | | $671.63 | $1,226.85 | $16,016.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.92 / $5,298.50 / $5,298.50
| Facility | AS | $187.92 | $5,298.50 | $5,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,798.70 / $18,725.22
| Facility | | $1,285.00 | $1,798.70 | $18,725.22 |
- 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 |