- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,760.83 / $14,791.08
| Facility | | $1,047.13 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $15,135.61 / $32,359.37
| Facility | | $3,890.45 | $15,135.61 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,165.95 / $12,882.50
| Facility | | $1,047.13 | $6,165.95 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,513.56
| Facility | | $1,047.13 | $1,047.13 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $933.25
| Facility | | $588.84 | $912.01 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,466.84 / $22,387.21
| Facility | | $2,344.23 | $4,466.84 | $22,387.21 |