- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,514.00 / $18,600.00
| Facility | | $1,456.00 | $5,514.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,588.83 / $13,548.97 / $21,558.31
| Facility | | $8,588.83 | $13,548.97 | $21,558.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.13 / $2,513.00 / $12,719.00
| Facility | | $1,670.13 | $2,513.00 | $12,719.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,105.03 / $2,105.03 / $2,105.03
| Facility | AS | $2,105.03 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,307.00 / $13,541.98
| Facility | | $1,851.00 | $7,307.00 | $13,541.98 |