- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.53 / $2,678.00 / $7,602.00
| Facility | | $1,094.53 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.00 / $5,486.00 / $9,283.00
| Facility | | $2,439.00 | $5,486.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,282.00 / $12,282.00 / $12,282.00
| Facility | | $12,282.00 | $12,282.00 | $12,282.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.13 / $17,070.15 / $26,542.00
| Facility | | $4,393.13 | $17,070.15 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $164.62 / $1,618.01 / $1,618.01
| Facility | AS | $164.62 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $19,000.00
| Facility | | $3,964.00 | $8,273.00 | $19,000.00 |