- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.91 / $4,732.00 / $11,581.00
| Facility | | $1,810.91 | $4,732.00 | $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
- $901.62 / $1,157.15 / $1,432.23
| Facility | | $901.62 | $1,157.15 | $1,432.23 |
- 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
- $1,154.44 / $2,275.64 / $5,690.76
| Facility | | $1,154.44 | $2,275.64 | $5,690.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.57 / $114.57 / $114.57
| Facility | AS | $114.57 | $114.57 | $114.57 |
- 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 |