- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.98 / $9,062.00 / $18,276.00
| Facility | | $2,039.98 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.82 / $27,416.96 / $43,667.88
| Facility | | $12,114.82 | $27,416.96 | $43,667.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $2,043.18
| Facility | | $890.00 | $890.00 | $2,043.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.55 / $202.55 / $202.55
| Facility | AS | $202.55 | $202.55 | $202.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.01 / $2,324.00 / $3,731.40
| Facility | | $1,930.01 | $2,324.00 | $3,731.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $294.01 / $325.36 / $522.40
| Facility | AS | $294.01 | $325.36 | $522.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $19,915.00 / $30,476.00
| Facility | | $3,340.00 | $19,915.00 | $30,476.00 |