- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.07 / $9,062.00 / $18,276.00
| Facility | | $1,413.07 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,836.04 / $15,050.77 / $25,571.79
| Facility | | $6,836.04 | $15,050.77 | $25,571.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $23,210.52
| Facility | | $715.00 | $1,100.00 | $23,210.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.02 / $139.02 / $139.02
| Facility | AS | $139.02 | $139.02 | $139.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.86 / $1,864.00 / $2,736.00
| Facility | | $1,377.86 | $1,864.00 | $2,736.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $212.83 / $294.70 / $409.85
| Facility | AS | $212.83 | $294.70 | $409.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |