- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.14 / $11,550.00 / $21,215.11
| Facility | | $1,556.14 | $11,550.00 | $21,215.11 |
- 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 / $1,554.13
| Facility | | $890.00 | $890.00 | $1,554.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.35 / $154.35 / $154.35
| Facility | AS | $154.35 | $154.35 | $154.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.63 / $1,837.00 / $2,999.97
| Facility | | $1,490.63 | $1,837.00 | $2,999.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.68 / $257.18 / $398.04
| Facility | AS | $218.68 | $257.18 | $398.04 |
- 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 |