- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.57 / $5,601.15 / $12,661.37
| Facility | | $1,130.57 | $5,601.15 | $12,661.37 |
- 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
- $690.28 / $885.92 / $1,176.61
| Facility | | $690.28 | $885.92 | $1,176.61 |
- 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
- $881.98 / $4,706.89 / $23,310.55
| Facility | | $881.98 | $4,706.89 | $23,310.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.65 / $87.65 / $87.65
| Facility | AS | $87.65 | $87.65 | $87.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,793.00 / $6,578.00 / $11,097.00
| Facility | | $3,793.00 | $6,578.00 | $11,097.00 |