- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,998.83 / $9,062.00 / $18,276.00
| Facility | | $1,998.83 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,313.35 / $8,268.12 / $17,077.74
| Facility | | $2,313.35 | $8,268.12 | $17,077.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.31 / $10,619.00 / $14,963.00
| Facility | | $1,963.31 | $10,619.00 | $14,963.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.61 / $194.61 / $194.61
| Facility | AS | $194.61 | $194.61 | $194.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.21 / $2,198.71 / $3,833.46
| Facility | | $1,816.21 | $2,198.71 | $3,833.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.73 / $301.42 / $500.69
| Facility | AS | $270.73 | $301.42 | $500.69 |
- 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 |