- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $16,982.44
| Facility | | $1,778.28 | $4,677.35 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $13,803.84
| Facility | | $2,344.23 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $17,378.01 / $22,387.21
| Facility | | $10,715.19 | $17,378.01 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $346.74 / $10,471.29
| Facility | | $199.53 | $346.74 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $104.71 / $104.71
| Facility | AS | $56.23 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $9,549.93
| Facility | | $338.84 | $707.95 | $9,549.93 |