- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,273.04 / $10,357.54 / $21,686.95
| Facility | | $6,273.04 | $10,357.54 | $21,686.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,053.26 / $10,104.21 / $20,202.15
| Facility | | $4,053.26 | $10,104.21 | $20,202.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $807.58 / $7,810.04
| Facility | | $580.00 | $807.58 | $7,810.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.34 / $80.34 / $80.34
| Facility | AS | $80.34 | $80.34 | $80.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.74 / $986.88 / $1,562.51
| Facility | | $796.74 | $986.88 | $1,562.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.89 / $141.12 / $209.58
| Facility | AS | $119.89 | $141.12 | $209.58 |
- 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 |