- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.61 / $9,062.00 / $18,276.00
| Facility | | $1,395.61 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,476.09 / $11,396.22 / $19,507.71
| Facility | | $5,476.09 | $11,396.22 | $19,507.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.86 / $5,740.31 / $14,963.00
| Facility | | $1,374.86 | $5,740.31 | $14,963.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.44 / $136.44 / $136.44
| Facility | AS | $136.44 | $136.44 | $136.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.04 / $1,513.55 / $2,627.83
| Facility | | $1,257.04 | $1,513.55 | $2,627.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.03 / $208.60 / $354.62
| Facility | AS | $189.03 | $208.60 | $354.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $17,146.00 / $24,161.00
| Facility | | $3,028.00 | $17,146.00 | $24,161.00 |