- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,354.69 / $7,044.00 / $11,627.00
| Facility | | $1,354.69 | $7,044.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,971.00 / $5,836.00 / $30,285.00
| Facility | | $2,971.00 | $5,836.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.70 / $936.50 / $1,243.80
| Facility | | $729.70 | $936.50 | $1,243.80 |
- 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
- $932.57 / $932.57 / $932.57
| Facility | | $932.57 | $932.57 | $932.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.68 / $92.68 / $92.68
| Facility | AS | $92.68 | $92.68 | $92.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |