- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.68 / $6,251.00 / $11,581.00
| Facility | | $1,396.68 | $6,251.00 | $11,581.00 |
- 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
- $852.53 / $1,094.16 / $1,453.19
| Facility | | $852.53 | $1,094.16 | $1,453.19 |
- 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
- $1,096.83 / $1,096.83 / $1,096.83
| Facility | | $1,096.83 | $1,096.83 | $1,096.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- 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 |