- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.83 / $8,876.00 / $16,467.00
| Facility | | $1,808.83 | $8,876.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.00 / $10,744.10 / $19,346.00
| Facility | | $3,543.00 | $10,744.10 | $19,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.03 / $890.00 / $2,581.96
| Facility | | $767.03 | $890.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.20 / $76.20 / $76.20
| Facility | AS | $76.20 | $76.20 | $76.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.82 / $923.17 / $1,474.06
| Facility | | $760.82 | $923.17 | $1,474.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.08 / $129.78 / $202.77
| Facility | AS | $117.08 | $129.78 | $202.77 |
- 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 |