- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.83 / $7,465.00 / $17,473.00
| Facility | | $1,799.83 | $7,465.00 | $17,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,746.00 / $30,285.00
| Facility | | $2,670.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.27 / $1,458.84 / $2,124.26
| Facility | | $1,337.27 | $1,458.84 | $2,124.26 |
- 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
- $1,694.77 / $1,694.77 / $1,694.77
| Facility | | $1,694.77 | $1,694.77 | $1,694.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.25 / $168.25 / $168.25
| Facility | AS | $168.25 | $168.25 | $168.25 |
- 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 |