- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,670.87 / $5,616.00 / $10,817.74
| Facility | | $1,670.87 | $5,616.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,528.00 / $14,996.00
| Facility | | $1,712.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.96 / $1,785.19 / $2,370.96
| Facility | | $1,390.96 | $1,785.19 | $2,370.96 |
- 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
- $1,773.58 / $1,773.58 / $7,667.32
| Facility | | $1,773.58 | $1,773.58 | $7,667.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.11 / $175.11 / $175.11
| Facility | AS | $175.11 | $175.11 | $175.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,522.00
| Facility | | $2,233.00 | $4,223.00 | $6,522.00 |