- 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
- $6,416.80 / $8,696.41 / $16,325.39
| Facility | | $6,416.80 | $8,696.41 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.52 / $414.22 / $4,317.00
| Facility | | $254.52 | $414.22 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.05 / $120.05 / $120.05
| Facility | AS | $120.05 | $120.05 | $120.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $581.61 / $822.79
| Facility | | $452.00 | $581.61 | $822.79 |
- 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 |