- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.29 / $9,062.00 / $18,276.00
| Facility | | $1,900.29 | $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 / $1,920.98
| Facility | | $890.00 | $890.00 | $1,920.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.33 / $190.33 / $190.33
| Facility | AS | $190.33 | $190.33 | $190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,811.32 / $2,280.35 / $3,704.58
| Facility | | $1,811.32 | $2,280.35 | $3,704.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.33 / $319.76 / $488.16
| Facility | AS | $270.33 | $319.76 | $488.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $21,721.00 / $33,364.00
| Facility | | $3,340.00 | $21,721.00 | $33,364.00 |