- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.38 / $10,032.00 / $13,865.00
| Facility | | $3,054.38 | $10,032.00 | $13,865.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,343.10 / $11,145.94 / $19,354.97
| Facility | | $4,343.10 | $11,145.94 | $19,354.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.08 / $5,740.31 / $14,963.00
| Facility | | $1,255.08 | $5,740.31 | $14,963.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.52 / $124.52 / $124.52
| Facility | AS | $124.52 | $124.52 | $124.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.23 / $1,483.54 / $2,582.46
| Facility | | $1,245.23 | $1,483.54 | $2,582.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,045.30 / $2,225.31 / $3,919.50
| Facility | 50 | $2,045.30 | $2,225.31 | $3,919.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.89 / $207.70 / $365.82
| Facility | AS | $190.89 | $207.70 | $365.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $17,146.00 / $24,161.00
| Facility | | $3,028.00 | $17,146.00 | $24,161.00 |