- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.39 / $7,155.00 / $11,627.00
| Facility | | $1,075.39 | $7,155.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,782.00 / $6,934.00 / $30,285.00
| Facility | | $2,782.00 | $6,934.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.53 / $901.63 / $1,197.48
| Facility | | $702.53 | $901.63 | $1,197.48 |
- 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
- $904.29 / $904.29 / $904.29
| Facility | | $904.29 | $904.29 | $904.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $90.00 / $90.00 / $90.00
| Facility | AS | $90.00 | $90.00 | $90.00 |
- 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 |