- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.02 / $13,423.20 / $24,468.57
| Facility | | $2,243.02 | $13,423.20 | $24,468.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,989.41 / $12,856.73 / $22,837.97
| Facility | | $5,989.41 | $12,856.73 | $22,837.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $957.12 / $13,857.70
| Facility | | $815.00 | $957.12 | $13,857.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.07 / $95.07 / $95.07
| Facility | AS | $95.07 | $95.07 | $95.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.98 / $1,156.06 / $1,843.15
| Facility | | $934.98 | $1,156.06 | $1,843.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.60 / $162.82 / $247.46
| Facility | AS | $138.60 | $162.82 | $247.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $20,341.00 / $27,446.00
| Facility | | $3,028.00 | $20,341.00 | $27,446.00 |