- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- 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
- $13,698.09 / $13,698.09 / $13,698.09
| Facility | | $13,698.09 | $13,698.09 | $13,698.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.49 / $1,390.48 / $9,696.00
| Facility | | $772.49 | $1,390.48 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.90 / $4,909.63 / $4,909.63
| Facility | AS | $218.90 | $4,909.63 | $4,909.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,262.48 / $2,118.17 / $18,558.13
| Facility | | $1,262.48 | $2,118.17 | $18,558.13 |
- 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 |