- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.91 / $5,829.95 / $11,627.00
| Facility | | $1,593.91 | $5,829.95 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.51 / $17,502.61 / $31,141.30
| Facility | | $6,794.51 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,580.74 / $1,724.45 / $2,511.05
| Facility | | $1,580.74 | $1,724.45 | $2,511.05 |
- 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
- $2,011.86 / $2,011.86 / $2,011.86
| Facility | | $2,011.86 | $2,011.86 | $2,011.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.12 / $199.12 / $199.12
| Facility | AS | $199.12 | $199.12 | $199.12 |
- 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 |