- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.11 / $5,135.00 / $10,817.74
| Facility | | $1,353.11 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $16,655.00 / $29,882.70
| Facility | | $3,405.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.76 / $1,068.78 / $1,419.48
| Facility | | $832.76 | $1,068.78 | $1,419.48 |
- 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
- $1,062.48 / $1,062.48 / $1,062.48
| Facility | | $1,062.48 | $1,062.48 | $1,062.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.51 / $105.51 / $105.51
| Facility | AS | $105.51 | $105.51 | $105.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |