- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.31 / $9,062.00 / $16,639.00
| Facility | | $1,208.31 | $9,062.00 | $16,639.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,654.25 / $18,669.81 / $34,857.08
| Facility | | $6,654.25 | $18,669.81 | $34,857.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $14,730.76
| Facility | | $580.00 | $890.00 | $14,730.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.97 / $118.97 / $118.97
| Facility | AS | $118.97 | $118.97 | $118.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.71 / $1,335.00 / $2,318.21
| Facility | | $1,125.71 | $1,335.00 | $2,318.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.21 / $186.90 / $311.14
| Facility | AS | $177.21 | $186.90 | $311.14 |
- 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 |