- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.43 / $4,969.92 / $11,581.00
| Facility | | $1,087.43 | $4,969.92 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,674.00 / $6,565.00 / $30,285.00
| Facility | | $2,674.00 | $6,565.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.63 / $730.50 / $1,063.71
| Facility | | $669.63 | $730.50 | $1,063.71 |
- 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
- $855.93 / $855.93 / $855.93
| Facility | | $855.93 | $855.93 | $855.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.08 / $85.08 / $85.08
| Facility | AS | $85.08 | $85.08 | $85.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |