- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $5,888.44 / $11,481.54
| Facility | | $588.84 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,000.00 / $57,543.99
| Facility | | $8,511.38 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,089.30 / $8,128.31
| Facility | | $645.65 | $2,089.30 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | AS | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,943.28 / $16,595.87
| Facility | | $2,238.72 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $5,128.61 / $10,000.00
| Facility | | $549.54 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $758.58
| Facility | | $524.81 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $588.84
| Facility | | $371.54 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $17,782.79
| Facility | | $1,584.89 | $4,168.69 | $17,782.79 |