- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.92 / $6,251.00 / $11,581.00
| Facility | | $2,125.92 | $6,251.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,405.00 / $29,300.94 / $53,822.78
| Facility | | $3,405.00 | $29,300.94 | $53,822.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.46 / $1,672.88 / $2,221.80
| Facility | | $1,303.46 | $1,672.88 | $2,221.80 |
- 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
- $1,668.85 / $1,668.85 / $1,668.85
| Facility | | $1,668.85 | $1,668.85 | $1,668.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.90 / $165.90 / $165.90
| Facility | AS | $165.90 | $165.90 | $165.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $8,928.00 / $14,134.00
| Facility | | $4,227.00 | $8,928.00 | $14,134.00 |