- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.84 / $7,181.36 / $22,776.00
| Facility | | $2,201.84 | $7,181.36 | $22,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,649.75 / $12,966.21 / $25,330.13
| Facility | | $3,649.75 | $12,966.21 | $25,330.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.45 / $2,000.00 / $7,789.73
| Facility | | $947.45 | $2,000.00 | $7,789.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.06 / $94.06 / $94.06
| Facility | AS | $94.06 | $94.06 | $94.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.01 / $1,062.85 / $1,808.83
| Facility | | $852.01 | $1,062.85 | $1,808.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.60 / $148.80 / $241.09
| Facility | AS | $135.60 | $148.80 | $241.09 |
- 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 |