- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.06 / $5,931.00 / $11,581.00
| Facility | | $1,848.06 | $5,931.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $7,086.00 / $30,285.00
| Facility | | $2,777.00 | $7,086.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.68 / $1,345.84 / $1,959.73
| Facility | | $1,233.68 | $1,345.84 | $1,959.73 |
- 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
- $1,567.52 / $1,567.52 / $1,567.52
| Facility | | $1,567.52 | $1,567.52 | $1,567.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $155.62 / $155.62 / $155.62
| Facility | AS | $155.62 | $155.62 | $155.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,522.00
| Facility | | $2,233.00 | $4,223.00 | $6,522.00 |