- 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
- $14,877.26 / $20,162.50 / $37,850.17
| Facility | | $14,877.26 | $20,162.50 | $37,850.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.30 / $1,399.39 / $7,856.00
| Facility | | $867.30 | $1,399.39 | $7,856.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $406.46 / $406.46 / $406.46
| Facility | AS | $406.46 | $406.46 | $406.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.00 / $1,967.13 / $2,760.39
| Facility | | $1,531.00 | $1,967.13 | $2,760.39 |
- 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 |