- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.16 / $6,582.00 / $11,581.00
| Facility | | $1,732.16 | $6,582.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.51 / $17,502.61 / $31,141.30
| Facility | | $6,794.51 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.21 / $1,368.40 / $1,817.40
| Facility | | $1,066.21 | $1,368.40 | $1,817.40 |
- 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
- $1,360.16 / $1,360.16 / $1,360.16
| Facility | | $1,360.16 | $1,360.16 | $1,360.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $135.00 / $135.00 / $135.00
| Facility | AS | $135.00 | $135.00 | $135.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,676.00
| Facility | | $4,070.00 | $8,440.00 | $13,676.00 |