- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.47 / $6,807.25 / $11,714.45
| Facility | | $1,371.47 | $6,807.25 | $11,714.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,971.00 / $6,934.00 / $30,285.00
| Facility | | $2,971.00 | $6,934.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.45 / $949.03 / $1,260.44
| Facility | | $739.45 | $949.03 | $1,260.44 |
- 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
- $947.45 / $947.45 / $947.45
| Facility | | $947.45 | $947.45 | $947.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.06 / $94.06 / $94.06
| Facility | AS | $94.06 | $94.06 | $94.06 |
- 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 |