- 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
- $9,426.81 / $12,775.74 / $23,983.33
| Facility | | $9,426.81 | $12,775.74 | $23,983.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.24 / $332.31 / $4,317.00
| Facility | | $206.24 | $332.31 | $4,317.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.34 / $97.34 / $97.34
| Facility | AS | $97.34 | $97.34 | $97.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.00 / $471.48 / $668.47
| Facility | | $354.00 | $471.48 | $668.47 |
- 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 |