- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,856.00 / $14,100.00
| Facility | | $1,392.00 | $4,856.00 | $14,100.00 |
- 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
- $15,025.30 / $15,025.30 / $15,025.30
| Facility | | $15,025.30 | $15,025.30 | $15,025.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.17 / $1,511.08 / $14,063.00
| Facility | | $1,088.17 | $1,511.08 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $265.38 / $5,010.81 / $5,010.81
| Facility | AS | $265.38 | $5,010.81 | $5,010.81 |
- 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 |