- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.32 / $8,876.00 / $16,627.30
| Facility | | $1,132.32 | $8,876.00 | $16,627.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,835.02 / $10,399.86 / $18,314.23
| Facility | | $4,835.02 | $10,399.86 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $5,740.31
| Facility | | $580.00 | $890.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.33 / $112.33 / $112.33
| Facility | AS | $112.33 | $112.33 | $112.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.29 / $1,280.00 / $2,159.61
| Facility | | $1,013.29 | $1,280.00 | $2,159.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.74 / $179.20 / $287.79
| Facility | AS | $145.74 | $179.20 | $287.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,298.00 / $15,713.00 / $25,628.00
| Facility | | $6,298.00 | $15,713.00 | $25,628.00 |