- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,195.75 / $12,462.61 / $23,395.49
| Facility | | $9,195.75 | $12,462.61 | $23,395.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.37 / $260.80 / $4,317.00
| Facility | | $146.37 | $260.80 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.33 / $69.33 / $69.33
| Facility | AS | $69.33 | $69.33 | $69.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.11 / $333.34 / $479.70
| Facility | | $270.11 | $333.34 | $479.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |