- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.26 / $9,062.00 / $27,038.11
| Facility | | $1,800.26 | $9,062.00 | $27,038.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,053.26 / $10,066.79 / $18,314.23
| Facility | | $4,053.26 | $10,066.79 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $772.24 / $5,740.31
| Facility | | $715.00 | $772.24 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.84 / $76.84 / $76.84
| Facility | AS | $76.84 | $76.84 | $76.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.34 / $949.00 / $1,483.20
| Facility | | $753.34 | $949.00 | $1,483.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.60 / $132.86 / $198.17
| Facility | AS | $112.60 | $132.86 | $198.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |