- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.36 / $6,251.00 / $11,581.00
| Facility | | $1,457.36 | $6,251.00 | $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
- $972.37 / $1,060.76 / $1,544.63
| Facility | | $972.37 | $1,060.76 | $1,544.63 |
- 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
- $1,240.63 / $1,240.63 / $1,240.63
| Facility | | $1,240.63 | $1,240.63 | $1,240.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.07 / $123.07 / $123.07
| Facility | AS | $123.07 | $123.07 | $123.07 |
- 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 |