- 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
- $597.29 / $846.00 / $4,406.00
| Facility | | $597.29 | $846.00 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $240.85 / $240.85 / $240.85
| Facility | AS | $240.85 | $240.85 | $240.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $889.00 / $1,157.92 / $1,577.16
| Facility | | $889.00 | $1,157.92 | $1,577.16 |
- 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 |