- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.08 / $6,251.00 / $11,581.00
| Facility | | $1,310.08 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $16,655.00 / $29,882.70
| Facility | | $3,315.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.21 / $1,399.20 / $1,731.81
| Facility | | $1,090.21 | $1,399.20 | $1,731.81 |
- 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
- $1,390.85 / $1,390.85 / $1,390.85
| Facility | | $1,390.85 | $1,390.85 | $1,390.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $137.94 / $137.94 / $137.94
| Facility | AS | $137.94 | $137.94 | $137.94 |
- 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 |