- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,611.47 / $24,068.03
| Facility | | $5,463.36 | $11,611.47 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,751.95 / $13,216.42 / $24,810.59
| Facility | | $9,751.95 | $13,216.42 | $24,810.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.92 / $426.67 / $3,930.50
| Facility | | $241.92 | $426.67 | $3,930.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $113.08 / $113.08 / $113.08
| Facility | AS | $113.08 | $113.08 | $113.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.75 / $568.86 / $770.66
| Facility | | $457.75 | $568.86 | $770.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |