- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.15 / $8,272.95 / $16,467.00
| Facility | | $1,982.15 | $8,272.95 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.54 / $10,148.12 / $18,314.23
| Facility | | $5,109.54 | $10,148.12 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $1,130.00 / $5,740.31
| Facility | | $848.49 | $1,130.00 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.11 / $84.11 / $84.11
| Facility | AS | $84.11 | $84.11 | $84.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.51 / $1,053.00 / $1,631.15
| Facility | | $826.51 | $1,053.00 | $1,631.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.35 / $147.41 / $218.06
| Facility | AS | $124.35 | $147.41 | $218.06 |
- 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 |