- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.21 / $9,062.00 / $18,276.00
| Facility | | $1,349.21 | $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 / $1,338.52
| Facility | | $890.00 | $890.00 | $1,338.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.94 / $132.94 / $132.94
| Facility | AS | $132.94 | $132.94 | $132.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.55 / $1,619.05 / $2,588.17
| Facility | | $1,306.55 | $1,619.05 | $2,588.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.10 / $231.28 / $346.46
| Facility | AS | $199.10 | $231.28 | $346.46 |
- 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 |