- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $9,608.62 / $24,068.03
| Facility | | $4,382.00 | $9,608.62 | $24,068.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,366.51 / $31,667.62 / $59,448.21
| Facility | | $23,366.51 | $31,667.62 | $59,448.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.60 / $1,414.23 / $29,797.02
| Facility | | $793.60 | $1,414.23 | $29,797.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,288.33 / $9,288.33 / $9,288.33
| Facility | AS | $9,288.33 | $9,288.33 | $9,288.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.00 / $1,906.01 / $32,825.51
| Facility | | $1,394.00 | $1,906.01 | $32,825.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,617.00 / $25,056.59 / $29,797.02
| Facility | | $9,617.00 | $25,056.59 | $29,797.02 |