- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.36 / $4,686.37 / $11,627.00
| Facility | | $1,309.36 | $4,686.37 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,003.00 / $30,285.00
| Facility | | $2,670.00 | $6,003.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.77 / $871.14 / $1,156.98
| Facility | | $678.77 | $871.14 | $1,156.98 |
- 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
- $867.84 / $4,922.68 / $17,870.25
| Facility | | $867.84 | $4,922.68 | $17,870.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.46 / $86.46 / $86.46
| Facility | AS | $86.46 | $86.46 | $86.46 |
- 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 |