- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,887.87 / $8,872.23 / $18,805.50
| Facility | | $1,887.87 | $8,872.23 | $18,805.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,794.51 / $17,502.61 / $31,141.30
| Facility | | $6,794.51 | $17,502.61 | $31,141.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.37 / $2,044.76 / $2,977.46
| Facility | | $1,874.37 | $2,044.76 | $2,977.46 |
- 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
- $2,375.41 / $2,375.41 / $2,375.41
| Facility | | $2,375.41 | $2,375.41 | $2,375.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $235.29 / $235.29 / $235.29
| Facility | AS | $235.29 | $235.29 | $235.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |