- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.47 / $9,062.00 / $18,276.00
| Facility | | $1,115.47 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $20,677.25
| Facility | | $4,783.09 | $10,824.58 | $20,677.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,096.83
| Facility | | $890.00 | $890.00 | $1,096.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.92 / $1,290.32 / $2,033.78
| Facility | | $1,004.92 | $1,290.32 | $2,033.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.15 / $182.14 / $268.85
| Facility | AS | $152.15 | $182.14 | $268.85 |
- 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 |