- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.77 / $4,044.00 / $10,268.00
| Facility | | $1,112.77 | $4,044.00 | $10,268.00 |
- 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
- $686.14 / $880.61 / $1,169.57
| Facility | | $686.14 | $880.61 | $1,169.57 |
- 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
- $877.51 / $877.51 / $877.51
| Facility | | $877.51 | $877.51 | $877.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.09 / $87.09 / $87.09
| Facility | AS | $87.09 | $87.09 | $87.09 |
- 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 |