- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.45 / $7,954.00 / $37,613.18
| Facility | | $1,659.45 | $7,954.00 | $37,613.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,531.00 / $18,682.34 / $27,646.96
| Facility | | $5,531.00 | $18,682.34 | $27,646.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.27 / $1,989.35 / $2,295.41
| Facility | | $1,530.27 | $1,989.35 | $2,295.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,980.11
| Facility | | $761.00 | $761.00 | $1,980.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.20 / $194.20 / $194.20
| Facility | AS | $194.20 | $194.20 | $194.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $10,860.00 / $17,649.00
| Facility | | $3,300.00 | $10,860.00 | $17,649.00 |