- 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
- $13,972.71 / $18,377.93 / $35,548.86
| Facility | | $13,972.71 | $18,377.93 | $35,548.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.14 / $341.50 / $4,406.00
| Facility | | $207.14 | $341.50 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.41 / $83.41 / $83.41
| Facility | AS | $83.41 | $83.41 | $83.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.57 / $405.84 / $577.74
| Facility | | $326.57 | $405.84 | $577.74 |
- 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 |