- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $23,483.17
| Facility | | $4,241.22 | $10,431.19 | $23,483.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,881.23 / $30,095.07 / $58,213.58
| Facility | | $22,881.23 | $30,095.07 | $58,213.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,157.02 / $27,157.02 / $27,157.02
| Facility | | $27,157.02 | $27,157.02 | $27,157.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.17 / $1,331.87 / $15,622.00
| Facility | | $734.17 | $1,331.87 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.89 / $9,733.53 / $9,733.53
| Facility | AS | $207.89 | $9,733.53 | $9,733.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $2,008.36 / $35,056.92
| Facility | | $1,480.00 | $2,008.36 | $35,056.92 |
- 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 |