- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.58 / $5,597.00 / $11,581.00
| Facility | | $1,115.58 | $5,597.00 | $11,581.00 |
- 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
- $676.85 / $738.38 / $1,075.19
| Facility | | $676.85 | $738.38 | $1,075.19 |
- 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
- $875.98 / $875.98 / $875.98
| Facility | | $875.98 | $875.98 | $875.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.09 / $87.09 / $87.09
| Facility | AS | $87.09 | $87.09 | $87.09 |
- 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 |