- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.11 / $7,198.00 / $19,086.00
| Facility | | $1,541.11 | $7,198.00 | $19,086.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,307.33 / $32,422.94 / $66,228.75
| Facility | | $4,307.33 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,729.31 / $5,291.35 / $12,729.05
| Facility | | $3,729.31 | $5,291.35 | $12,729.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.13 / $183.13 / $183.13
| Facility | AS | $183.13 | $183.13 | $183.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,390.28 / $4,837.56 / $10,022.87
| Facility | | $3,390.28 | $4,837.56 | $10,022.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.24 / $3,106.36 / $10,744.00
| Facility | | $1,695.24 | $3,106.36 | $10,744.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.38 / $398.38 / $398.38
| Facility | AS | $398.38 | $398.38 | $398.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $5,530.00 / $12,774.00
| Facility | | $1,356.00 | $5,530.00 | $12,774.00 |