- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.15 / $9,062.00 / $18,276.00
| Facility | | $1,445.15 | $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 / $1,433.27
| Facility | | $890.00 | $890.00 | $1,433.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.16 / $142.16 / $142.16
| Facility | AS | $142.16 | $142.16 | $142.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.62 / $1,750.33 / $2,777.28
| Facility | | $1,403.62 | $1,750.33 | $2,777.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.76 / $252.56 / $372.51
| Facility | AS | $214.76 | $252.56 | $372.51 |
- 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 |