- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.18 / $4,934.00 / $11,581.00
| Facility | | $1,136.18 | $4,934.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $9,021.00 / $30,285.00
| Facility | | $2,777.00 | $9,021.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.46 / $1,135.13 / $1,507.59
| Facility | | $884.46 | $1,135.13 | $1,507.59 |
- 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
- $1,126.75 / $2,896.34 / $7,191.68
| Facility | | $1,126.75 | $2,896.34 | $7,191.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.77 / $111.77 / $111.77
| Facility | AS | $111.77 | $111.77 | $111.77 |
- 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 |