- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $7,155.00 / $11,581.00
| Facility | | $2,264.00 | $7,155.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $7,086.00 / $30,285.00
| Facility | | $2,777.00 | $7,086.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.04 / $1,686.59 / $2,455.91
| Facility | | $1,546.04 | $1,686.59 | $2,455.91 |
- 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
- $1,963.31 / $1,963.31 / $1,963.31
| Facility | | $1,963.31 | $1,963.31 | $1,963.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.61 / $194.61 / $194.61
| Facility | AS | $194.61 | $194.61 | $194.61 |
- 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 |