- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.14 / $11,503.74 / $16,467.00
| Facility | | $1,547.14 | $11,503.74 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.10 / $10,704.30 / $19,274.58
| Facility | | $4,248.10 | $10,704.30 | $19,274.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $669.94 / $2,581.96
| Facility | | $580.00 | $669.94 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.47 / $66.47 / $66.47
| Facility | AS | $66.47 | $66.47 | $66.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.15 / $833.85 / $1,293.00
| Facility | | $644.15 | $833.85 | $1,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.69 / $117.46 / $181.02
| Facility | AS | $97.69 | $117.46 | $181.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.48 / $17,146.00 / $24,161.00
| Facility | | $2,401.48 | $17,146.00 | $24,161.00 |