- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.81 / $4,197.00 / $10,268.00
| Facility | | $1,009.81 | $4,197.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,528.00 / $14,996.00
| Facility | | $1,712.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.57 / $797.74 / $1,059.50
| Facility | | $621.57 | $797.74 | $1,059.50 |
- 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
- $792.20 / $792.20 / $792.20
| Facility | | $792.20 | $792.20 | $792.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.67 / $78.67 / $78.67
| Facility | AS | $78.67 | $78.67 | $78.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,522.00
| Facility | | $2,233.00 | $4,223.00 | $6,522.00 |