- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,841.17 / $9,062.00 / $18,276.00
| Facility | | $1,841.17 | $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 / $1,848.40
| Facility | | $890.00 | $890.00 | $1,848.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.94 / $182.94 / $182.94
| Facility | AS | $182.94 | $182.94 | $182.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.80 / $2,108.00 / $3,587.14
| Facility | | $1,775.80 | $2,108.00 | $3,587.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $259.56 / $295.12 / $471.76
| Facility | AS | $259.56 | $295.12 | $471.76 |
- 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 |