- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.20 / $9,062.00 / $18,276.00
| Facility | | $1,684.20 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,401.93 / $21,277.44 / $33,889.28
| Facility | | $9,401.93 | $21,277.44 | $33,889.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,668.85
| Facility | | $890.00 | $890.00 | $1,668.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.90 / $165.90 / $165.90
| Facility | AS | $165.90 | $165.90 | $165.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.55 / $1,950.51 / $3,170.79
| Facility | | $1,597.55 | $1,950.51 | $3,170.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.58 / $282.52 / $423.05
| Facility | AS | $230.58 | $282.52 | $423.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,766.00 / $17,186.00 / $24,729.00
| Facility | | $8,766.00 | $17,186.00 | $24,729.00 |