- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.40 / $5,355.00 / $10,817.74
| Facility | | $1,070.40 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $5,770.00 / $30,285.00
| Facility | | $2,670.00 | $5,770.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.60 / $973.61 / $1,205.06
| Facility | | $758.60 | $973.61 | $1,205.06 |
- 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
- $972.74 / $972.74 / $972.74
| Facility | | $972.74 | $972.74 | $972.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.93 / $96.93 / $96.93
| Facility | AS | $96.93 | $96.93 | $96.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |