- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.60 / $9,062.00 / $18,276.00
| Facility | | $1,260.60 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,401.93 / $21,277.44 / $33,889.28
| Facility | | $9,401.93 | $21,277.44 | $33,889.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,250.74
| Facility | | $890.00 | $890.00 | $1,250.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.19 / $124.19 / $124.19
| Facility | AS | $124.19 | $124.19 | $124.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.82 / $1,512.73 / $2,421.92
| Facility | | $1,219.82 | $1,512.73 | $2,421.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.14 / $214.76 / $323.49
| Facility | AS | $182.14 | $214.76 | $323.49 |
- 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 |