- 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
- $576.75 / $800.92 / $12,335.40
| Facility | | $576.75 | $800.92 | $12,335.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $232.52 / $232.52 / $232.52
| Facility | AS | $232.52 | $232.52 | $232.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $1,117.89 / $1,522.58
| Facility | | $834.00 | $1,117.89 | $1,522.58 |
- 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 |