- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.41 / $9,976.87 / $19,298.50
| Facility | | $7,585.41 | $9,976.87 | $19,298.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.61 / $634.95 / $4,406.00
| Facility | | $462.61 | $634.95 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.11 / $187.11 / $187.11
| Facility | AS | $187.11 | $187.11 | $187.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.08 / $901.07 / $1,284.77
| Facility | | $725.08 | $901.07 | $1,284.77 |
- 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 |