- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,253.30 / $7,501.00 / $12,672.00
| Facility | | $1,253.30 | $7,501.00 | $12,672.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,443.00 / $29,300.94 / $53,822.78
| Facility | | $2,443.00 | $29,300.94 | $53,822.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.89 / $692.60 / $1,008.52
| Facility | | $634.89 | $692.60 | $1,008.52 |
- 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
- $809.07 / $809.07 / $809.07
| Facility | | $809.07 | $809.07 | $809.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.45 / $80.45 / $80.45
| Facility | AS | $80.45 | $80.45 | $80.45 |
- 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 |