- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.66 / $6,756.00 / $14,500.00
| Facility | | $1,857.66 | $6,756.00 | $14,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $29,300.94 / $53,822.78
| Facility | | $3,315.00 | $29,300.94 | $53,822.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.96 / $1,480.32 / $2,155.54
| Facility | | $1,356.96 | $1,480.32 | $2,155.54 |
- 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
- $1,724.24 / $1,724.24 / $1,724.24
| Facility | | $1,724.24 | $1,724.24 | $1,724.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.46 / $171.46 / $171.46
| Facility | AS | $171.46 | $171.46 | $171.46 |
- 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 |