- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.08 / $5,201.00 / $11,243.00
| Facility | | $1,256.08 | $5,201.00 | $11,243.00 |
- 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
- $639.65 / $820.94 / $1,090.32
| Facility | | $639.65 | $820.94 | $1,090.32 |
- 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
- $821.34 / $821.34 / $821.34
| Facility | | $821.34 | $821.34 | $821.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.31 / $81.31 / $81.31
| Facility | AS | $81.31 | $81.31 | $81.31 |
- 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 |