- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,948.82 / $6,756.00 / $14,500.00
| Facility | | $1,948.82 | $6,756.00 | $14,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,541.00 / $41,639.47 / $76,926.81
| Facility | | $3,541.00 | $41,639.47 | $76,926.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.34 / $1,562.56 / $2,275.30
| Facility | | $1,432.34 | $1,562.56 | $2,275.30 |
- 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
- $1,815.20 / $1,815.20 / $1,815.20
| Facility | | $1,815.20 | $1,815.20 | $1,815.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.56 / $180.56 / $180.56
| Facility | AS | $180.56 | $180.56 | $180.56 |
- 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 |