- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.07 / $5,135.00 / $10,817.74
| Facility | | $1,043.07 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $16,655.00 / $29,882.70
| Facility | | $3,315.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $644.46 / $827.11 / $1,098.51
| Facility | | $644.46 | $827.11 | $1,098.51 |
- 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
- $823.57 / $823.57 / $823.57
| Facility | | $823.57 | $823.57 | $823.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.56 / $81.56 / $81.56
| Facility | AS | $81.56 | $81.56 | $81.56 |
- 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 |