- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.24 / $6,251.00 / $11,581.00
| Facility | | $1,077.24 | $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
- $663.05 / $850.97 / $1,130.19
| Facility | | $663.05 | $850.97 | $1,130.19 |
- 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
- $845.76 / $845.76 / $845.76
| Facility | | $845.76 | $845.76 | $845.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.03 / $84.03 / $84.03
| Facility | AS | $84.03 | $84.03 | $84.03 |
- 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 |