- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.73 / $5,634.36 / $10,956.00
| Facility | | $1,100.73 | $5,634.36 | $10,956.00 |
- 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
- $592.89 / $760.93 / $1,010.61
| Facility | | $592.89 | $760.93 | $1,010.61 |
- 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
- $759.22 / $1,862.06 / $2,636.98
| Facility | | $759.22 | $1,862.06 | $2,636.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.45 / $75.45 / $75.45
| Facility | AS | $75.45 | $75.45 | $75.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,920.00 / $7,821.00
| Facility | | $2,840.00 | $5,920.00 | $7,821.00 |