- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.64 / $9,062.00 / $18,276.00
| Facility | | $1,163.64 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,155.76
| Facility | | $890.00 | $890.00 | $1,155.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.90 / $114.90 / $114.90
| Facility | AS | $114.90 | $114.90 | $114.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.98 / $1,354.00 / $2,223.66
| Facility | | $1,055.98 | $1,354.00 | $2,223.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.01 / $189.56 / $297.14
| Facility | AS | $169.01 | $189.56 | $297.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |