- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.04 / $6,251.00 / $11,581.00
| Facility | | $1,616.04 | $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
- $1,047.85 / $1,344.85 / $1,786.13
| Facility | | $1,047.85 | $1,344.85 | $1,786.13 |
- 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
- $1,338.52 / $1,338.52 / $1,338.52
| Facility | | $1,338.52 | $1,338.52 | $1,338.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.94 / $132.94 / $132.94
| Facility | AS | $132.94 | $132.94 | $132.94 |
- 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 |