- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,246.83 / $4,085.00 / $11,581.00
| Facility | | $1,246.83 | $4,085.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,746.00 / $30,285.00
| Facility | | $2,670.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.85 / $862.26 / $1,145.19
| Facility | | $671.85 | $862.26 | $1,145.19 |
- 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
- $858.91 / $858.91 / $858.91
| Facility | | $858.91 | $858.91 | $858.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.34 / $85.34 / $85.34
| Facility | AS | $85.34 | $85.34 | $85.34 |
- 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 |