- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.48 / $7,532.92 / $11,627.00
| Facility | | $2,064.48 | $7,532.92 | $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
- $2,058.51 / $2,245.64 / $3,269.96
| Facility | | $2,058.51 | $2,245.64 | $3,269.96 |
- 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
- $2,606.76 / $2,606.76 / $2,606.76
| Facility | | $2,606.76 | $2,606.76 | $2,606.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.00 / $3,098.00 / $6,111.00
| Facility | | $1,771.00 | $3,098.00 | $6,111.00 |