- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.10 / $5,223.00 / $10,635.00
| Facility | | $1,208.10 | $5,223.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,134.00 / $7,398.00 / $36,529.00
| Facility | | $2,134.00 | $7,398.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.26 / $956.48 / $1,270.33
| Facility | | $745.26 | $956.48 | $1,270.33 |
- 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
- $953.40 / $953.40 / $953.40
| Facility | | $953.40 | $953.40 | $953.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.58 / $94.58 / $94.58
| Facility | AS | $94.58 | $94.58 | $94.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $9,067.00 / $14,156.00
| Facility | | $4,227.00 | $9,067.00 | $14,156.00 |