- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.17 / $1,976.45 / $20,481.00
| Facility | | $1,235.17 | $1,976.45 | $20,481.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.17 / $1,729.00 / $2,579.52
| Facility | | $1,235.17 | $1,729.00 | $2,579.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.47 / $242.06 / $390.81
| Facility | AS | $219.47 | $242.06 | $390.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,126.62 / $10,126.62
| Facility | | $55.00 | $10,126.62 | $10,126.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.53 / $320.97 / $631.60
| Facility | AS | $177.53 | $320.97 | $631.60 |