- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.06 / $4,286.17 / $13,875.12
| Facility | | $1,171.06 | $4,286.17 | $13,875.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,850.00 / $16,455.00 / $26,582.19
| Facility | | $8,850.00 | $16,455.00 | $26,582.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.35 / $1,267.35 / $1,267.35
| Facility | | $1,267.35 | $1,267.35 | $1,267.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.35 / $126.35 / $126.35
| Facility | AS | $126.35 | $126.35 | $126.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,726.43 / $12,267.97 / $57,117.84
| Facility | | $2,726.43 | $12,267.97 | $57,117.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.06 / $4,432.00 / $15,844.57
| Facility | | $1,171.06 | $4,432.00 | $15,844.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.35 / $1,267.35 / $1,267.35
| Facility | | $1,267.35 | $1,267.35 | $1,267.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.35 / $126.35 / $126.35
| Facility | AS | $126.35 | $126.35 | $126.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.08 / $1,097.08 / $1,097.08
| Facility | | $1,097.08 | $1,097.08 | $1,097.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $9,631.00
| Facility | | $2,468.00 | $4,563.00 | $9,631.00 |