- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.16 / $4,557.00 / $21,700.37
| Facility | | $902.16 | $4,557.00 | $21,700.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,161.39 / $12,446.60 / $25,424.06
| Facility | | $4,161.39 | $12,446.60 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,195.48 / $3,115.09 / $7,493.76
| Facility | | $2,195.48 | $3,115.09 | $7,493.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.45 / $102.45 / $102.45
| Facility | AS | $102.45 | $102.45 | $102.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.90 / $2,847.94 / $5,900.60
| Facility | | $1,995.90 | $2,847.94 | $5,900.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.77 / $1,577.24 / $7,145.24
| Facility | | $926.77 | $1,577.24 | $7,145.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.05 / $233.05 / $233.05
| Facility | AS | $233.05 | $233.05 | $233.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |