- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.86 / $4,728.00 / $14,100.00
| Facility | | $1,348.86 | $4,728.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,271.71 / $17,815.62 / $28,366.81
| Facility | | $11,271.71 | $17,815.62 | $28,366.81 |
- 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
- $1,030.00 / $1,708.43 / $7,405.00
| Facility | | $1,030.00 | $1,708.43 | $7,405.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $545.58 / $545.58 / $545.58
| Facility | AS | $545.58 | $545.58 | $545.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |