- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.96 / $9,062.00 / $18,276.00
| Facility | | $1,881.96 | $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 / $1,869.23
| Facility | | $890.00 | $890.00 | $1,869.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.84 / $184.84 / $184.84
| Facility | AS | $184.84 | $184.84 | $184.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.15 / $2,232.00 / $3,656.53
| Facility | | $1,831.15 | $2,232.00 | $3,656.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $283.27 / $322.83 / $490.41
| Facility | AS | $283.27 | $322.83 | $490.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.00 / $15,713.00 / $23,485.00
| Facility | | $1,303.00 | $15,713.00 | $23,485.00 |