- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.20 / $5,201.00 / $11,627.00
| Facility | | $1,063.20 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.00 / $7,398.00 / $36,529.00
| Facility | | $2,097.00 | $7,398.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.40 / $1,023.40 / $1,359.20
| Facility | | $797.40 | $1,023.40 | $1,359.20 |
- 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
- $1,018.50 / $1,018.50 / $1,018.50
| Facility | | $1,018.50 | $1,018.50 | $1,018.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.30 / $101.30 / $101.30
| Facility | AS | $101.30 | $101.30 | $101.30 |
- 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 |