- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $13,200.00
| Facility | | $1,346.00 | $4,195.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,885.22 / $22,885.22 / $22,885.22
| Facility | | $22,885.22 | $22,885.22 | $22,885.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.72 / $1,866.01 / $14,063.00
| Facility | | $1,296.72 | $1,866.01 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $313.63 / $7,632.03 / $7,632.03
| Facility | AS | $313.63 | $7,632.03 | $7,632.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $14,139.00
| Facility | | $1,851.00 | $7,307.00 | $14,139.00 |