- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.69 / $11,018.00 / $25,040.15
| Facility | | $1,139.69 | $11,018.00 | $25,040.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.53 / $10,253.54 / $17,240.66
| Facility | | $4,752.53 | $10,253.54 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,130.08
| Facility | | $890.00 | $890.00 | $1,130.08 |
- 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
- $1,090.69 / $1,377.03 / $2,184.77
| Facility | | $1,090.69 | $1,377.03 | $2,184.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $167.27 / $197.68 / $291.75
| Facility | AS | $167.27 | $197.68 | $291.75 |
- 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 |