- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,660.84 / $9,062.00 / $19,696.93
| Facility | | $6,660.84 | $9,062.00 | $19,696.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.10 / $11,086.48 / $19,407.11
| Facility | | $4,248.10 | $11,086.48 | $19,407.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.83 / $2,345.00 / $5,740.31
| Facility | | $1,149.83 | $2,345.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.08 / $114.08 / $114.08
| Facility | AS | $114.08 | $114.08 | $114.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.41 / $1,367.11 / $2,219.09
| Facility | | $1,128.41 | $1,367.11 | $2,219.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.20 / $191.40 / $303.77
| Facility | AS | $187.20 | $191.40 | $303.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,628.00 / $19,766.00 / $25,620.00
| Facility | | $4,628.00 | $19,766.00 | $25,620.00 |