- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.41 / $11,025.00 / $16,467.00
| Facility | | $1,804.41 | $11,025.00 | $16,467.00 |
- 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 / $1,797.43
| Facility | | $890.00 | $890.00 | $1,797.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.36 / $178.36 / $178.36
| Facility | AS | $178.36 | $178.36 | $178.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.70 / $2,110.04 / $3,500.20
| Facility | | $1,748.70 | $2,110.04 | $3,500.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $260.12 / $298.33 / $465.92
| Facility | AS | $260.12 | $298.33 | $465.92 |
- 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 |