- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.01 / $6,756.00 / $14,500.00
| Facility | | $2,066.01 | $6,756.00 | $14,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $41,878.69 / $76,926.81
| Facility | | $3,405.00 | $41,878.69 | $76,926.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.31 / $1,645.43 / $2,395.96
| Facility | | $1,508.31 | $1,645.43 | $2,395.96 |
- 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
- $1,920.98 / $1,920.98 / $1,920.98
| Facility | | $1,920.98 | $1,920.98 | $1,920.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.33 / $190.33 / $190.33
| Facility | AS | $190.33 | $190.33 | $190.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,873.00 / $10,529.00 / $15,469.00
| Facility | | $4,873.00 | $10,529.00 | $15,469.00 |