- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.86 / $5,616.00 / $11,581.00
| Facility | | $1,036.86 | $5,616.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $3,528.00 / $14,996.00
| Facility | | $1,525.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.61 / $817.04 / $1,085.13
| Facility | | $636.61 | $817.04 | $1,085.13 |
- 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
- $814.85 / $814.85 / $814.85
| Facility | | $814.85 | $814.85 | $814.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.45 / $79.45 / $79.45
| Facility | AS | $79.45 | $79.45 | $79.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.00 / $4,404.00 / $7,427.00
| Facility | | $2,647.00 | $4,404.00 | $7,427.00 |