- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $18,620.87
| Facility | | $2,454.71 | $6,760.83 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $13,803.84
| Facility | | $3,630.78 | $6,165.95 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $3,630.78 / $21,379.62
| Facility | | $66.07 | $3,630.78 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,840.32
| Facility | | $28,183.83 | $28,183.83 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $426.58 / $575.44
| Professional | | $263.03 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $870.96
| Professional | | $346.74 | $457.09 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $83,176.38
| Facility | | $44,668.36 | $44,668.36 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | AS | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $537.03 / $851.14
| Facility | | $389.05 | $537.03 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,952.62 / $52,480.75
| Facility | | $10,000.00 | $19,952.62 | $52,480.75 |