- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,382.02 / $7,866.95 / $11,909.00
| Facility | | $2,382.02 | $7,866.95 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,860.32 / $10,419.11 / $18,018.52
| Facility | | $4,860.32 | $10,419.11 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,018.50 / $14,552.97
| Facility | | $715.00 | $1,018.50 | $14,552.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.30 / $101.30 / $101.30
| Facility | AS | $101.30 | $101.30 | $101.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.78 / $1,230.00 / $1,962.11
| Facility | | $990.78 | $1,230.00 | $1,962.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.47 / $172.20 / $261.87
| Facility | AS | $149.47 | $172.20 | $261.87 |
- 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 |