- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.84 / $7,414.00 / $11,832.15
| Facility | | $952.84 | $7,414.00 | $11,832.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.72 / $31,774.48 / $66,228.75
| Facility | | $4,516.72 | $31,774.48 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,314.19 / $3,283.50 / $7,898.91
| Facility | | $2,314.19 | $3,283.50 | $7,898.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.27 / $108.27 / $108.27
| Facility | AS | $108.27 | $108.27 | $108.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.81 / $3,001.91 / $6,219.61
| Facility | | $2,103.81 | $3,001.91 | $6,219.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.52 / $1,784.50 / $9,370.00
| Facility | | $1,014.52 | $1,784.50 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.06 / $246.06 / $246.06
| Facility | AS | $246.06 | $246.06 | $246.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $13,109.00
| Facility | | $5,577.00 | $10,743.00 | $13,109.00 |