- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.27 / $8,008.72 / $11,679.00
| Facility | | $1,525.27 | $8,008.72 | $11,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,920.00 / $17,502.61 / $31,141.30
| Facility | | $5,920.00 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.58 / $1,650.08 / $2,402.73
| Facility | | $1,512.58 | $1,650.08 | $2,402.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.51 / $1,928.51 / $1,928.51
| Facility | | $1,928.51 | $1,928.51 | $1,928.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.74 / $190.74 / $190.74
| Facility | AS | $190.74 | $190.74 | $190.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |