- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.18 / $4,424.00 / $11,243.00
| Facility | | $1,108.18 | $4,424.00 | $11,243.00 |
- 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
- $902.68 / $1,158.52 / $1,538.66
| Facility | | $902.68 | $1,158.52 | $1,538.66 |
- 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
- $1,149.83 / $4,374.92 / $6,012.84
| Facility | | $1,149.83 | $4,374.92 | $6,012.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.08 / $114.08 / $114.08
| Facility | AS | $114.08 | $114.08 | $114.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $8,928.00 / $14,134.00
| Facility | | $4,227.00 | $8,928.00 | $14,134.00 |