- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.92 / $7,501.00 / $17,112.00
| Facility | | $1,632.92 | $7,501.00 | $17,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,020.00 / $29,300.94 / $53,822.78
| Facility | | $6,020.00 | $29,300.94 | $53,822.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.33 / $1,290.26 / $1,713.63
| Facility | | $1,005.33 | $1,290.26 | $1,713.63 |
- 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
- $1,282.30 / $1,282.30 / $1,282.30
| Facility | | $1,282.30 | $1,282.30 | $1,282.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.24 / $127.24 / $127.24
| Facility | AS | $127.24 | $127.24 | $127.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,534.00 / $9,067.00 / $22,000.00
| Facility | | $4,534.00 | $9,067.00 | $22,000.00 |