- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.08 / $5,356.00 / $11,581.00
| Facility | | $1,240.08 | $5,356.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $5,770.00 / $30,285.00
| Facility | | $2,777.00 | $5,770.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $667.80 / $857.06 / $1,138.29
| Facility | | $667.80 | $857.06 | $1,138.29 |
- 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
- $857.80 / $857.80 / $14,247.63
| Facility | | $857.80 | $857.80 | $14,247.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.30 / $85.30 / $85.30
| Facility | AS | $85.30 | $85.30 | $85.30 |
- 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 |