- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,958.01 / $11,269.00 / $19,696.93
| Facility | | $1,958.01 | $11,269.00 | $19,696.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,049.08 / $15,089.42 / $25,571.79
| Facility | | $7,049.08 | $15,089.42 | $25,571.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $836.97 / $16,221.41
| Facility | | $715.00 | $836.97 | $16,221.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.10 / $83.10 / $83.10
| Facility | AS | $83.10 | $83.10 | $83.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.00 / $1,001.27 / $1,608.26
| Facility | | $801.00 | $1,001.27 | $1,608.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.06 / $144.62 / $214.61
| Facility | AS | $116.06 | $144.62 | $214.61 |
- 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 |