- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.57 / $4,804.00 / $10,620.21
| Facility | | $1,854.57 | $4,804.00 | $10,620.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,701.50 / $24,163.00 / $64,800.00
| Facility | | $7,701.50 | $24,163.00 | $64,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,043.18
| Facility | | $895.00 | $950.00 | $2,043.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.55 / $202.55 / $202.55
| Facility | AS | $202.55 | $202.55 | $202.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |