- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.71 / $7,654.00 / $11,581.00
| Facility | | $1,653.71 | $7,654.00 | $11,581.00 |
- 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
- $1,104.36 / $1,204.76 / $1,754.31
| Facility | | $1,104.36 | $1,204.76 | $1,754.31 |
- 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
- $1,403.28 / $1,403.28 / $1,403.28
| Facility | | $1,403.28 | $1,403.28 | $1,403.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.43 / $139.43 / $139.43
| Facility | AS | $139.43 | $139.43 | $139.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $9,125.00 / $18,211.00
| Facility | | $4,227.00 | $9,125.00 | $18,211.00 |