- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,107.20 / $9,863.00 / $23,893.11
| Facility | | $5,107.20 | $9,863.00 | $23,893.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,788.13 / $13,758.44 / $24,747.74
| Facility | | $5,788.13 | $13,758.44 | $24,747.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $822.46 / $7,538.14
| Facility | | $580.00 | $822.46 | $7,538.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.76 / $81.76 / $81.76
| Facility | AS | $81.76 | $81.76 | $81.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.82 / $852.12 / $1,578.53
| Facility | | $716.82 | $852.12 | $1,578.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.24 / $119.30 / $211.39
| Facility | AS | $114.24 | $119.30 | $211.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $19,766.00 / $25,620.00
| Facility | | $4,628.00 | $19,766.00 | $25,620.00 |