- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $6,582.00 / $11,581.00
| Facility | | $1,375.00 | $6,582.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.00 / $16,268.05 / $29,882.70
| Facility | | $2,118.00 | $16,268.05 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.44 / $950.66 / $1,384.29
| Facility | | $871.44 | $950.66 | $1,384.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.36 / $1,110.36 / $1,110.36
| Facility | | $1,110.36 | $1,110.36 | $1,110.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.17 / $110.17 / $110.17
| Facility | AS | $110.17 | $110.17 | $110.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |