- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.41 / $6,582.00 / $10,822.69
| Facility | | $1,520.41 | $6,582.00 | $10,822.69 |
- 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
- $1,003.51 / $1,204.21 / $1,505.27
| Facility | | $1,003.51 | $1,204.21 | $1,505.27 |
- 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
- $1,200.77 / $6,344.43 / $8,904.54
| Facility | | $1,200.77 | $6,344.43 | $8,904.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.08 / $119.08 / $119.08
| Facility | AS | $119.08 | $119.08 | $119.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $9,125.00 / $13,382.00
| Facility | | $4,070.00 | $9,125.00 | $13,382.00 |