- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.40 / $9,062.00 / $18,276.00
| Facility | | $1,222.40 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,821.65 / $19,232.43 / $34,283.46
| Facility | | $7,821.65 | $19,232.43 | $34,283.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,217.95 / $23,039.24
| Facility | | $890.00 | $1,217.95 | $23,039.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.06 / $121.06 / $121.06
| Facility | AS | $121.06 | $121.06 | $121.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.38 / $1,308.29 / $2,151.21
| Facility | | $1,122.38 | $1,308.29 | $2,151.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.55 / $183.16 / $267.51
| Facility | AS | $174.55 | $183.16 | $267.51 |
- 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 |