- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.52 / $5,447.00 / $11,061.59
| Facility | | $1,041.52 | $5,447.00 | $11,061.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,003.00 / $30,285.00
| Facility | | $2,670.00 | $6,003.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.95 / $825.18 / $1,095.95
| Facility | | $642.95 | $825.18 | $1,095.95 |
- 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
- $823.94 / $823.94 / $6,683.04
| Facility | | $823.94 | $823.94 | $6,683.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.69 / $81.69 / $81.69
| Facility | AS | $81.69 | $81.69 | $81.69 |
- 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 |