- 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
- $33,735.08 / $44,370.85 / $85,827.55
| Facility | | $33,735.08 | $44,370.85 | $85,827.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.46 / $261.42 / $4,406.00
| Facility | | $190.46 | $261.42 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.05 / $77.05 / $77.05
| Facility | AS | $77.05 | $77.05 | $77.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.39 / $370.82 / $528.71
| Facility | | $298.39 | $370.82 | $528.71 |
- 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 |