- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.31 / $6,582.00 / $11,581.00
| Facility | | $1,260.31 | $6,582.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,746.00 / $30,285.00
| Facility | | $2,670.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.63 / $996.74 / $1,323.80
| Facility | | $776.63 | $996.74 | $1,323.80 |
- 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
- $991.71 / $991.71 / $991.71
| Facility | | $991.71 | $991.71 | $991.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $98.50 / $98.50 / $98.50
| Facility | AS | $98.50 | $98.50 | $98.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |