- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.93 / $9,062.00 / $18,276.00
| Facility | | $2,027.93 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $2,036.65
| Facility | | $890.00 | $890.00 | $2,036.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.26 / $202.26 / $202.26
| Facility | AS | $202.26 | $202.26 | $202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.08 / $2,361.00 / $3,969.96
| Facility | | $1,938.08 | $2,361.00 | $3,969.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $288.95 / $330.54 / $517.42
| Facility | AS | $288.95 | $330.54 | $517.42 |
- 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 |