- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.13 / $3,830.00 / $8,240.00
| Facility | | $1,033.13 | $3,830.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.30 / $1,129.30 / $1,129.30
| Facility | | $1,129.30 | $1,129.30 | $1,129.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,597.00 / $8,404.00
| Facility | | $1,020.00 | $4,597.00 | $8,404.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.30 / $1,129.30 / $1,129.30
| Facility | | $1,129.30 | $1,129.30 | $1,129.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.35 / $974.35 / $1,141.06
| Facility | | $974.35 | $974.35 | $1,141.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,879.00 / $7,508.00
| Facility | | $2,332.00 | $3,879.00 | $7,508.00 |