- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.02 / $1,423.02 / $7,397.00
| Facility | | $1,423.02 | $1,423.02 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,839.48 / $31,774.48 / $66,228.75
| Facility | | $6,839.48 | $31,774.48 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,451.50 / $4,897.18 / $11,780.84
| Facility | | $3,451.50 | $4,897.18 | $11,780.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.59 / $162.59 / $162.59
| Facility | AS | $162.59 | $162.59 | $162.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.73 / $4,477.20 / $9,276.25
| Facility | | $3,137.73 | $4,477.20 | $9,276.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.39 / $2,476.30 / $7,527.00
| Facility | | $1,472.39 | $2,476.30 | $7,527.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $367.74 / $367.74 / $367.74
| Facility | AS | $367.74 | $367.74 | $367.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $13,341.00 / $60,840.24
| Facility | | $5,028.00 | $13,341.00 | $60,840.24 |