- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,511.20 / $9,102.79 / $21,886.00
| Facility | | $3,511.20 | $9,102.79 | $21,886.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,635.78 / $14,313.12 / $25,571.79
| Facility | | $5,635.78 | $14,313.12 | $25,571.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,100.00 / $14,693.33
| Facility | | $715.00 | $1,100.00 | $14,693.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.31 / $149.31 / $149.31
| Facility | AS | $149.31 | $149.31 | $149.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.51 / $1,772.00 / $2,887.86
| Facility | | $1,430.51 | $1,772.00 | $2,887.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.22 / $248.08 / $381.72
| Facility | AS | $213.22 | $248.08 | $381.72 |
- 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 |