- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.32 / $6,756.00 / $16,112.00
| Facility | | $2,003.32 | $6,756.00 | $16,112.00 |
- 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
- $1,333.98 / $1,455.25 / $2,119.05
| Facility | | $1,333.98 | $1,455.25 | $2,119.05 |
- 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
- $1,700.59 / $1,700.59 / $1,700.59
| Facility | | $1,700.59 | $1,700.59 | $1,700.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.44 / $168.44 / $168.44
| Facility | AS | $168.44 | $168.44 | $168.44 |
- 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 |