- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $6,251.00 / $11,581.00
| Facility | | $2,264.00 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $16,655.00 / $29,882.70
| Facility | | $3,405.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.27 / $1,542.84 / $2,246.59
| Facility | | $1,414.27 | $1,542.84 | $2,246.59 |
- 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
- $1,797.43 / $1,797.43 / $1,797.43
| Facility | | $1,797.43 | $1,797.43 | $1,797.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.36 / $178.36 / $178.36
| Facility | AS | $178.36 | $178.36 | $178.36 |
- 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 |