- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.14 / $6,391.06 / $11,561.00
| Facility | | $1,226.14 | $6,391.06 | $11,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,230.00 / $6,934.00 / $30,285.00
| Facility | | $3,230.00 | $6,934.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.83 / $850.69 / $1,129.83
| Facility | | $662.83 | $850.69 | $1,129.83 |
- 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
- $850.72 / $2,781.95 / $4,622.52
| Facility | | $850.72 | $2,781.95 | $4,622.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.26 / $84.26 / $84.26
| Facility | AS | $84.26 | $84.26 | $84.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |