- 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
- $205.47 / $293.20 / $4,406.00
| Facility | | $205.47 | $293.20 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.96 / $82.96 / $82.96
| Facility | AS | $82.96 | $82.96 | $82.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.00 / $398.84 / $543.77
| Facility | | $311.00 | $398.84 | $543.77 |
- 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 |